Provider Demographics
NPI:1306070321
Name:WEIR, ROBERT D (LMT, MMP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:WEIR
Suffix:
Gender:M
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8424 SANDOWNE LN
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5635
Mailing Address - Country:US
Mailing Address - Phone:704-756-0909
Mailing Address - Fax:
Practice Address - Street 1:8424 SANDOWNE LN
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5635
Practice Address - Country:US
Practice Address - Phone:704-756-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3040225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist