Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 001647 | KY |
NPI | 1063684272 |
---|---|
Provider Name | Lisa Weaver |
First Address | Florence, KY 41042-1539 |
Second Address | Crescent Springs, KY 41017-4473 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2008 |
Last Update Date | 19/08/2019 |