Healthcare Provider Details

I. General information

NPI: 1912426818
Provider Name (Legal Business Name): KELLEY MAYER WEAVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 09/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9085 TOWN CENTER PARKWAY
BRADENTON FL
34202
US

IV. Provider business mailing address

1612 ORACLE DR
RUSKIN FL
33573-6620
US

V. Phone/Fax

Practice location:
  • Phone: 941-549-8844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: