Provider Demographics
NPI:1285112011
Name:WEAVER, ANN SHRECKHISE (DPT)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:SHRECKHISE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1561 COMMERCE RD # 402
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:VA
Mailing Address - Zip Code:24482-9701
Mailing Address - Country:US
Mailing Address - Phone:540-416-0530
Mailing Address - Fax:540-416-0531
Practice Address - Street 1:1561 COMMERCE RD # 402
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:VA
Practice Address - Zip Code:24482-9701
Practice Address - Country:US
Practice Address - Phone:540-416-0530
Practice Address - Fax:540-416-0531
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305212232OtherLICENSE