Individual
DIANE MARIE WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1111 TRINITY LN STE 111, BLOOMINGTON, IL 61704-8112
(309) 608-5100
Mailing address
611 W PARK, FAPC, CHAMPAIGN, IL 61802
(217) 902-6954
(217) 902-7711
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070017881
IL
225100000X
Physical Therapist
11334-024
WI
225100000X
Physical Therapist
18133
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215107776
—
WI
Enumeration date
03/11/2008
Last updated
12/31/2024
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