Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 014743-1 | NY |
N | 2251S0007X | Physical Therapist - Sports | PT20541 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | 014743-1 | NY |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT20541 | CA |
NPI | 1184862013 |
---|---|
Provider Name | Ms. Lucinda Weaver I |
First Address | Gualala, CA 95445-1441 |
Second Address | Gualala, CA 95445 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2009 |
Last Update Date | 16/10/2020 |