Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5501004344 | MI |
NPI | 1003048836 |
---|---|
Provider Name | Sharon Weaver |
First Address | Waterford, MI 48328-1439 |
Second Address | Waterford, MI 48328-1439 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2009 |
Last Update Date | 12/08/2009 |