Provider Demographics
NPI:1063639417
Name:WEAVER, JEAN LYNN (PT)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:LYNN
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 1:2899 W STATE ROUTE 18
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-8950
Mailing Address - Country:US
Mailing Address - Phone:419-937-1677
Mailing Address - Fax:
Practice Address - Street 1:2899 W STATE ROUTE 18
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-8950
Practice Address - Country:US
Practice Address - Phone:419-937-1677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-5404225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist