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General NPI Number Information
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NPI Number | 1447804687
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Entity Type | Individual
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Provider Name | GAVIN WEIR III PT, DPT, CSCS
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Gender | Male
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Dates
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Enumeration Date | 07/25/2019
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Last Update Date | 01/26/2021
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Provider Practice Location Address
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Address Line | 706 CENTER RD
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City | FRANKFORT
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State | IL
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Zip | 60423-1600
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Country | US
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Telephone | 312-857-8180
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Fax |
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Provider Business Mailing Address
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Address Line | 17200 OAK PARK AVE UNIT 306
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City | TINLEY PARK
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State | IL
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Zip | 60477-3639
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Country | US
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Telephone | 312-857-8180
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 6356
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License Number State | ID
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