Individual
CALVIN EUGENE WEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
2521 W LEOTA ST, NORTH PLATTE, NE 69101-6365
(308) 530-3253
Mailing address
2521 W LEOTA ST, NORTH PLATTE, NE 69101-6365
(308) 530-3253
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
1154
NE
225200000X
Physical Therapy Assistant
Primary
2086896
TX
225200000X
Physical Therapy Assistant
A-0875
NM
225200000X
Physical Therapy Assistant
PTA.0012931
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H12883018
DRIVERS LICENSE
NE
Enumeration date
12/05/2012
Last updated
12/05/2012
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