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General NPI Number Information
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NPI Number | 1063684272
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Entity Type | Individual
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Provider Name | LISA WEAVER P.T.
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Gender | Female
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 08/19/2019
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Provider Practice Location Address
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Address Line | 2083 LAKELYN CT
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City | CRESCENT SPRINGS
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State | KY
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Zip | 41017-4473
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Country | US
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Telephone | 859-803-8890
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Fax | 859-813-2574
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Provider Business Mailing Address
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Address Line | 40 UTZ DR
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City | FLORENCE
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State | KY
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Zip | 41042-1539
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Country | US
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Telephone | 859-912-1081
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 001647
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License Number State | KY
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