Individual
JACK GAFFNEY WEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5001 GUNPOWDER RD, FAIRFAX, VA 22030-6508
(571) 230-8525
Mailing address
5001 GUNPOWDER RD, FAIRFAX, VA 22030-6508
(571) 230-8525
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
VA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
VA
Other
Enumeration date
09/29/2025
Last updated
09/29/2025
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