MEDICARE: DR. KARI MICHELLE WEAVER PT, DPT

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	25704	MA

General Provider Information

NPI Number	:	1679249577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARI MICHELLE WEAVER PT, DPT

Provider Business Mailing Address
First Line	:	8 MEADOW GLEN DR
Second Line	:
City	:	GRANBY
State	:	MA
Zip	:	01033-9567
Country	:	US
Telephone Number	:	413-467-2344
Fax Number	:

Provider Business Practice Location Address
First Line	:	766 N KING ST
Second Line	:
City	:	NORTHAMPTON
State	:	MA
Zip	:	01060-1142
Country	:	US
Telephone Number	:	413-586-0230
Fax Number	:

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

Provider Enumeration Date	:	08/19/2021
Last Update Date	:	08/19/2021

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