Individual
MALLORY WEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
333 WHEAT RIDGE DR, EPHRATA, PA 17522-8558
(717) 354-1800
Mailing address
1304 BUNNY VIEW DR, LITITZ, PA 17543-8833
(717) 507-7269
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
TEI003986
PA
Other
Enumeration date
09/06/2021
Last updated
09/06/2021
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