Healthcare Provider Details

I. General information

NPI: 1225639933
Provider Name (Legal Business Name): CELESTINE MARIE WEUVE PHD, ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE UNIVERSITY PLAZA MS SLB 16
SPRINGFIELD IL
62703
US

IV. Provider business mailing address

1 UNIVERSITY PLZ
SPRINGFIELD IL
62703-5497
US

V. Phone/Fax

Practice location:
  • Phone: 217-206-8414
  • Fax:
Mailing address:
  • Phone: 217-206-8414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096.004601
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: