Provider Demographics
NPI:1508106014
Name:WEAVER, DENSISE (PT)
Entity Type:Individual
Prefix:
First Name:DENSISE
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SOUTHSIDE DR STE 206
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3894
Mailing Address - Country:US
Mailing Address - Phone:518-280-4294
Mailing Address - Fax:518-280-4297
Practice Address - Street 1:7 SOUTHSIDE DR STE 206
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3894
Practice Address - Country:US
Practice Address - Phone:518-280-4294
Practice Address - Fax:518-280-4297
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0127102251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics