Individual
PHILIP WEIVODA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
235 ROAD 1399, TUPELO, MS 38804-7537
(503) 351-6211
Mailing address
235 ROAD 1399, TUPELO, MS 38804-7537
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0731
MS
Other
Enumeration date
11/03/2021
Last updated
11/03/2021
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