Provider Demographics
NPI:1215965389
Name:WEAVER, GERMAINE (PT)
Entity type:Individual
Prefix:
First Name:GERMAINE
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 1:2299 PEARL ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-4668
Mailing Address - Country:US
Mailing Address - Phone:303-444-2233
Mailing Address - Fax:866-543-1887
Practice Address - Street 1:2299 PEARL ST
Practice Address - Street 2:SUITE 301
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4668
Practice Address - Country:US
Practice Address - Phone:303-444-2233
Practice Address - Fax:866-543-1887
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10913225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA104077Medicare PIN