Individual
MATTISON MARIE WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
550 CLUB LN, CONWAY, AR 72034-3681
(501) 329-1510
Mailing address
15 KIMBERLY DR, VILONIA, AR 72173-9018
(501) 733-0710
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
235500000X
Speech/Language/Hearing Specialist/Technologist
—
—
Other
Enumeration date
08/01/2017
Last updated
08/01/2017
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