Individual
KRISTEN M WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., P.T.
Contact information
Practice address
1445 GALAXY DR NE, LACEY, WA 98516
(360) 456-1444
Mailing address
11711 NE 12TH ST, STE 3A, BELLEVUE, WA 98005-2461
(425) 450-9474
(425) 452-0704
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
5501011977
MI
225100000X
Physical Therapist
Primary
PT60041800
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386895894
—
WA
05
—
2002864
—
WA
01
—
5501011977
MICHIGAN STATE LICENSE
MI
Enumeration date
10/02/2008
Last updated
07/27/2021
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