Individual
MR. MATTHEW ROGER WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
1523 COLUMBIA TURNPIKE, SERENITY DAY SPA, CASTLETON, NY 12033-9544
(518) 479-5680
Mailing address
171 TEAL ROAD, SAND LAKE, NY 12153
(518) 674-4033
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
013854-1
NY
Other
Enumeration date
10/15/2008
Last updated
10/15/2008
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