Healthcare Provider Details

I. General information

NPI: 1760969067
Provider Name (Legal Business Name): LEAH ANNE WEAVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2567 NILES VIENNA RD
NILES OH
44446-5401
US

IV. Provider business mailing address

2565 NILES VIENNA RD
NILES OH
44446-4401
US

V. Phone/Fax

Practice location:
  • Phone: 814-288-8978
  • Fax:
Mailing address:
  • Phone: 216-772-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT026868
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: