Provider Demographics
NPI:1891182200
Name:WEEDON, STEVE (AT/LAT, MED)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:WEEDON
Suffix:
Gender:M
Credentials:AT/LAT, MED
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:ALLEN
Other - Last Name:WEEDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AT/ LAT, MED
Mailing Address - Street 1:1218 KINGSTON GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36067-1704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1218 KINGSTON GARDEN RD
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36067-1704
Practice Address - Country:US
Practice Address - Phone:334-313-5616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer