Individual
KELSI WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4347 W GAY RD, DIBERVILLE, MS 39540-3412
(228) 392-8484
Mailing address
711 AVIGNON DR, RIDGELAND, MS 39157-5120
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT6825
MS
Other
Enumeration date
04/20/2020
Last updated
04/20/2020
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