Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter |
NPI | 1487962726 |
---|---|
Provider Name | Mr. Gary Kent Weaver JR. |
First Address | Knoxville, TN 37919-6052 |
Second Address | Knoxville, TN 37919-6052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2010 |
Last Update Date | 27/02/2017 |