Healthcare Provider Details

I. General information

NPI: 1790904191
Provider Name (Legal Business Name): DARLA JOAN WEAVER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 S ELM ST
PARIS AR
72855-4924
US

IV. Provider business mailing address

227 DUBBS WAY
BOONEVILLE AR
72927-7849
US

V. Phone/Fax

Practice location:
  • Phone: 479-963-6151
  • Fax: 479-963-3331
Mailing address:
  • Phone: 479-675-2898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT1447
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1447
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: