Provider Demographics
NPI:1962759910
Name:WEAVER, DOUGLAS CARL (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:CARL
Last Name:WEAVER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 MCCRACKEN RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-9590
Mailing Address - Country:US
Mailing Address - Phone:570-394-2284
Mailing Address - Fax:
Practice Address - Street 1:1615 S FEDERAL HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-7468
Practice Address - Country:US
Practice Address - Phone:866-291-3694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3705225100000X
MN8953225100000X
WAPT 60290244225100000X
TX1220729225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist