MEDICARE: MRS. YAMILE WEAVER RPT

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	225100000X	Physical Therapist	PT 18772	FL

General Provider Information

NPI Number	:	1881634749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YAMILE WEAVER RPT

Provider Business Mailing Address
First Line	:	2423 SW 147TH AVE
Second Line	:	137
City	:	MIAMI
State	:	FL
Zip	:	33185-4082
Country	:	US
Telephone Number	:	786-237-4986
Fax Number	:	786-237-4986

Provider Business Practice Location Address
First Line	:	2423 SW 147TH AVE
Second Line	:	137
City	:	MIAMI
State	:	FL
Zip	:	33185-4082
Country	:	US
Telephone Number	:	786-237-4986
Fax Number	:	786-237-4986

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	07/08/2007

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