Provider Demographics
NPI:1205994043
Name:WEAVER, KRISTINA LYNN (PTA)
Entity type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:LYNN
Last Name:WEAVER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23 HOBAN CT
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4757
Mailing Address - Country:US
Mailing Address - Phone:410-583-1515
Mailing Address - Fax:410-583-2491
Practice Address - Street 1:1026 CROMWELL BRIDGE RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3308
Practice Address - Country:US
Practice Address - Phone:410-583-1515
Practice Address - Fax:410-583-2491
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1952225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant