MEDICARE: MR. MATTHEW WEAVER LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	33.013673	OH

General Provider Information

NPI Number	:	1578002473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW WEAVER LMT

Provider Business Mailing Address
First Line	:	3683 GARDEN COURT
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-2906
Country	:	US
Telephone Number	:	614-305-5071
Fax Number	:	614-801-0090

Provider Business Practice Location Address
First Line	:	51 S. STANFIELD RD.
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-2992
Country	:	US
Telephone Number	:	937-335-2722
Fax Number	:	937-339-6775

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2017
Last Update Date	:	02/13/2017

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Directions to “ MR. MATTHEW WEAVER LMT” Practice Location

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