Provider Demographics
NPI:1679834212
Name:WEAVER, LAURIE L (LPTA)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:L
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 ARKANSAS 230
Mailing Address - Street 2:
Mailing Address - City:CAVE CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72521-9534
Mailing Address - Country:US
Mailing Address - Phone:870-283-9877
Mailing Address - Fax:
Practice Address - Street 1:551 ARKANSAS 230
Practice Address - Street 2:
Practice Address - City:CAVE CITY
Practice Address - State:AR
Practice Address - Zip Code:72521-9534
Practice Address - Country:US
Practice Address - Phone:870-283-9877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA2637225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant