Individual
SAMUEL WATSON WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
618 FLOREY ST, KILGORE, TX 75662-3502
(903) 240-6790
Mailing address
618 FLOREY ST, KILGORE, TX 75662-3502
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2096735
TX
Other
Enumeration date
02/17/2021
Last updated
02/17/2021
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