Provider Demographics
NPI:1740341528
Name:WEAVER, DANIEL TODD (PT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:TODD
Last Name:WEAVER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 33RD ST S STE 210
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-9668
Mailing Address - Country:US
Mailing Address - Phone:320-240-6955
Mailing Address - Fax:320-240-8089
Practice Address - Street 1:251 COUNTY ROAD 120
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-259-5429
Practice Address - Fax:320-240-8905
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8B792WEOtherBLUE CROSS BLUE SHIELD
MNHP43511OtherHEALTHPARTNERS
MN133482000Medicaid
MN264M1NOOtherBLUE CROSS BLUE SHIELD OF MN
MN6411228OtherMEDICA
MN6411228OtherSELECT CARE
MN8B792WEOtherBLUE CROSS BLUE SHIELD
MN133482000Medicaid
MNHP43511OtherHEALTHPARTNERS