Provider Demographics
NPI:1023324944
Name:WEAVER, CHRISTOPHER MORRIS (LPTA)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MORRIS
Last Name:WEAVER
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 THICKET CV
Mailing Address - Street 2:
Mailing Address - City:BELDEN
Mailing Address - State:MS
Mailing Address - Zip Code:38826-6008
Mailing Address - Country:US
Mailing Address - Phone:662-617-3771
Mailing Address - Fax:
Practice Address - Street 1:1700 THICKET CV
Practice Address - Street 2:
Practice Address - City:BELDEN
Practice Address - State:MS
Practice Address - Zip Code:38826-6008
Practice Address - Country:US
Practice Address - Phone:662-617-3771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA4436171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor