Provider Demographics
NPI:1649436023
Name:WEAVER, MICHELE BUSIC (MS, PT)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:BUSIC
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9435 DEER HOLW
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-1655
Mailing Address - Country:US
Mailing Address - Phone:440-478-4919
Mailing Address - Fax:
Practice Address - Street 1:9435 DEER HOLW
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-1655
Practice Address - Country:US
Practice Address - Phone:440-478-4919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-08201225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist