MEDICARE: NOLAN WEAVER DPT

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	2251X0800X	Orthopedic Physical Therapist	PT028404	PA

General Provider Information

NPI Number	:	1942821913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOLAN WEAVER DPT

Provider Business Mailing Address
First Line	:	4826 SILVERWOOD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-4544
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1426 FRANKFORD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-4410
Country	:	US
Telephone Number	:	215-427-6024
Fax Number	:

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

Provider Enumeration Date	:	05/01/2020
Last Update Date	:	05/01/2020

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Directions to “ NOLAN WEAVER DPT” Practice Location

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