MEDICARE: SCOTT WEAVER P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1487647814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT WEAVER P.T.

Provider Business Mailing Address
First Line	:	115 E GRAND RIVER AVE
Second Line	:	PO BOX 202
City	:	FOWLERVILLE
State	:	MI
Zip	:	48836
Country	:	US
Telephone Number	:	517-223-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 E GRAND RIVER AVE
Second Line	:
City	:	FOWLERVILLE
State	:	MI
Zip	:	48836
Country	:	US
Telephone Number	:	517-223-2100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	07/08/2007

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Directions to “ SCOTT WEAVER P.T.” Practice Location

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