=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851631030
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CINDY L WEAVER PTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2013
-----------------------------------------------------
Last Update Date | 02/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 295 W GENEVA ST
-----------------------------------------------------
City | DUNKIRK
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45836-1008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-203-5464
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 295 W GENEVA ST
-----------------------------------------------------
City | DUNKIRK
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45836-1008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-203-5464
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 02545
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------