Healthcare Provider Details

I. General information

NPI: 1780814285
Provider Name (Legal Business Name): RYAN L WEAVER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 07/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S MAIN ST
MANHEIM PA
17545-1677
US

IV. Provider business mailing address

75 EVELYN DR
MILLERSBURG PA
17061-1258
US

V. Phone/Fax

Practice location:
  • Phone: 717-665-0400
  • Fax: 717-665-0402
Mailing address:
  • Phone: 717-692-4708
  • Fax: 717-692-5464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT020048
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: