MEDICARE: KATHLEEN WEAVER

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	174400000X	Specialist	PT005495L	PA

General Provider Information

NPI Number	:	1801039698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN WEAVER

Provider Business Mailing Address
First Line	:	101 E STATE ST
Second Line	:
City	:	KENNETT SQUARE
State	:	PA
Zip	:	19348-3109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 SAINT LUKE DR
Second Line	:
City	:	LITITZ
State	:	PA
Zip	:	17543-2208
Country	:	US
Telephone Number	:	717-626-6884
Fax Number	:	717-625-0937

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

Provider Enumeration Date	:	04/09/2009
Last Update Date	:	04/09/2009

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Directions to “ KATHLEEN WEAVER ” Practice Location

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