Healthcare Provider Details

I. General information

NPI: 1861008047
Provider Name (Legal Business Name): DANIEL WEAVER LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 WASHINGTON BLVD APT 102
ARLINGTON VA
22201-1101
US

IV. Provider business mailing address

2300 WASHINGTON BLVD APT 102
ARLINGTON VA
22201-1101
US

V. Phone/Fax

Practice location:
  • Phone: 301-653-7078
  • Fax:
Mailing address:
  • Phone: 301-653-7078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305217143
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019016366
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: