Provider Demographics
NPI:1922078112
Name:WEAVER, ERIC PAUL II (PT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:PAUL
Last Name:WEAVER
Suffix:II
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7733 FORSYTH BLVD
Mailing Address - Street 2:1700
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1817
Mailing Address - Country:US
Mailing Address - Phone:800-677-1238
Mailing Address - Fax:786-275-0096
Practice Address - Street 1:8345 CORAL WAY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1138
Practice Address - Country:US
Practice Address - Phone:786-275-0200
Practice Address - Fax:786-275-0096
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008002488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0652AMedicare ID - Type UnspecifiedMEDICARE NUMBER