Provider Demographics
NPI:1922032044
Name:WEAVER, ADAM P (DPT)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:P
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 1:6010 EXECUTIVE BLVD
Mailing Address - Street 2:SUITE 704
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3809
Mailing Address - Country:US
Mailing Address - Phone:301-231-0095
Mailing Address - Fax:301-231-0092
Practice Address - Street 1:4701 RANDOLPH ROAD, SUITE G-1
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852
Practice Address - Country:US
Practice Address - Phone:301-231-0095
Practice Address - Fax:301-231-0092
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
018330525Medicare ID - Type Unspecified