Provider Demographics
NPI:1982041489
Name:WEAVER, REBECCA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7935 60TH ST N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-2217
Mailing Address - Country:US
Mailing Address - Phone:727-667-4146
Mailing Address - Fax:
Practice Address - Street 1:13002 SEMINOLE BLVD STE 4
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-2125
Practice Address - Country:US
Practice Address - Phone:727-585-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA71755225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist