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General NPI Number Information
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NPI Number | 1770971889
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Entity Type | Organization
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Legal Business Name | KEVIN WEAVER PT PC
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Dates
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Enumeration Date | 12/26/2014
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Last Update Date | 12/26/2014
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Provider Practice Location Address
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Address Line | 1160 5TH AVE STE 103
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City | NEW YORK
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State | NY
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Zip | 10029-6928
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Country | US
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Telephone | 212-426-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 2453 FARMERS AVE
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City | BELLMORE
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State | NY
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Zip | 11710-3814
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KEVIN C WEAVER
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Credential |
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Telephone | 516-707-8606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 0115531
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License Number State | NY
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