Provider Demographics
NPI:1205060811
Name:WEAVER, STEPHANIE L (CMT, NCBTMB)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:L
Last Name:WEAVER
Suffix:
Gender:F
Credentials:CMT, NCBTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17070-1720
Mailing Address - Country:US
Mailing Address - Phone:717-649-1640
Mailing Address - Fax:
Practice Address - Street 1:616 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:NEW CUMBERLAND
Practice Address - State:PA
Practice Address - Zip Code:17070-1720
Practice Address - Country:US
Practice Address - Phone:717-649-1640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist