Provider Demographics
NPI:1720011448
Name:WEAVER & ASSOCIATES INC
Entity Type:Organization
Organization Name:WEAVER & ASSOCIATES INC
Other - Org Name:NORTH HAGERSTOWN REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:301-745-8915
Mailing Address - Street 1:580 NORTHERN AVE STE F
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2847
Mailing Address - Country:US
Mailing Address - Phone:301-745-8915
Mailing Address - Fax:301-745-8916
Practice Address - Street 1:580 NORTHERN AVE STE F
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2847
Practice Address - Country:US
Practice Address - Phone:301-745-8915
Practice Address - Fax:301-745-8916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD412893100Medicaid
MDP00222631OtherMEDICARE RAILROAD
MD960MMedicare PIN
MDP00222631OtherMEDICARE RAILROAD