Provider Demographics
NPI:1487081899
Name:WEED, TABITHA ASHLEY (PT)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:ASHLEY
Last Name:WEED
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 1:5107 COUNTY ROAD 2214
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36079-4216
Mailing Address - Country:US
Mailing Address - Phone:334-372-0476
Mailing Address - Fax:
Practice Address - Street 1:5107 COUNTY ROAD 2214
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36079-4216
Practice Address - Country:US
Practice Address - Phone:334-372-0476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011195225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist