Provider Demographics
NPI:1730661133
Name:WEAVER, JEANNETTE AMIE (PT)
Entity Type:Individual
Prefix:MISS
First Name:JEANNETTE
Middle Name:AMIE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 ALEXANDER AVE APT 4325
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-2464
Mailing Address - Country:US
Mailing Address - Phone:985-960-6159
Mailing Address - Fax:
Practice Address - Street 1:1700 ONION CREEK PKWY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-1948
Practice Address - Country:US
Practice Address - Phone:512-291-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1289566225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist