Individual
FENTA R WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1 LBJ SR DR, FORT WALTON BEACH, FL 32547
(850) 863-2066
Mailing address
1729 COLONIAL CT, FT WALTON BCH, FL 32547-6883
(850) 319-2497
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
22798
FL
Other
Enumeration date
11/22/2022
Last updated
11/22/2022
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