Individual
MALLORY DANIELLE WEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20243 COUNTY ROAD 684A, SWEENY, TX 77480-7034
(979) 373-7661
Mailing address
20243 COUNTY ROAD 684A, SWEENY, TX 77480-7034
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/05/2019
Last updated
03/05/2019
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