Provider Demographics
NPI:1790068757
Name:WEAVER, JASON DUANE (DPT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DUANE
Last Name:WEAVER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 COUNTY ROAD 70
Mailing Address - Street 2:
Mailing Address - City:THORSBY
Mailing Address - State:AL
Mailing Address - Zip Code:35171
Mailing Address - Country:US
Mailing Address - Phone:205-688-4472
Mailing Address - Fax:
Practice Address - Street 1:1824 GLYNWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066
Practice Address - Country:US
Practice Address - Phone:334-361-4711
Practice Address - Fax:334-361-8219
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH6267225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist