Provider Demographics
NPI:1922659499
Name:LUCINDA WEAVER PHYSICAL THERAPY
Entity Type:Organization
Organization Name:LUCINDA WEAVER PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:707-884-4800
Mailing Address - Street 1:PO BOX 1441
Mailing Address - Street 2:
Mailing Address - City:GUALALA
Mailing Address - State:CA
Mailing Address - Zip Code:95445-1441
Mailing Address - Country:US
Mailing Address - Phone:707-884-4800
Mailing Address - Fax:707-884-4808
Practice Address - Street 1:39120 OCEAN DR
Practice Address - Street 2:
Practice Address - City:GUALALA
Practice Address - State:CA
Practice Address - Zip Code:95445
Practice Address - Country:US
Practice Address - Phone:707-884-4800
Practice Address - Fax:707-884-4808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-25
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy