Provider Demographics
NPI:1386345056
Name:WEAVER, BRET ELSWORTH (NATABOC)
Entity type:Individual
Prefix:
First Name:BRET
Middle Name:ELSWORTH
Last Name:WEAVER
Suffix:
Gender:M
Credentials:NATABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 CREEK MEADOW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-6084
Mailing Address - Country:US
Mailing Address - Phone:719-728-0176
Mailing Address - Fax:
Practice Address - Street 1:11426 DODSON TRL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-4622
Practice Address - Country:US
Practice Address - Phone:719-728-0176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No171000000XOther Service ProvidersMilitary Health Care Provider