Lucinda Weaver I, M.P.T.
Individual provider Active NPI Orthopedic Physical Therapist · Gualala, CA
NPI 1184862013 · NPPES record last updated Oct 16, 2020
Key facts
- NPI
- 1184862013
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthopedic Physical Therapist 2251X0800X
- License
- PT20541 (CA)
- Practice address
- 39120 Ocean Dr.
Gualala, CA 95445 - Phone
- (707) 884-4800
- Fax
- (707) 884-4808
- NPI assigned
- Jan 30, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
39120 Ocean Dr
Gualala, CA 95445
Phone (707) 844-8400
PO Box
Suite 93
Gualala, CA 95445
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140513001591 | CA | Practitioner - Physical Therapist in Private Practice | 2365665668 |
Reassigns benefits to 1 organization Practice locations: Gualala, CA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT20541 | CA | MD | Sports Physical Therapist |
| 014743-1 | NY | MD | Surgical Physician Assistant |
| 20541 | CA | MD | Student in an Organized Health Care Education/Training Program |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lucinda Weaver Physical Therapy | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Physical Therapist | 2251S0007X | 014743-1 | NY | |
| Sports Physical Therapist | 2251S0007X | PT20541 | CA | |
| Orthopedic Physical Therapist | 2251X0800X | 014743-1 | NY | |
| Orthopedic Physical Therapist | 2251X0800X | PT20541 | CA | Yes |
Addresses
Primary practice location
39120 Ocean Dr.
Gualala, CA 95445
Mailing address
PO Box 1441
Gualala, CA 95445-1441
Phone (707) 884-4800
Other providers in Gualala, CA
- Roberta U. Rams
- Redwood Coast Medical Services, Inc.
- William M Schieve
- Karen Petersen Scott
- Laundon Transue
- Caithleen Paterson Zikorus
- Adele Zita
All providers in Gualala, CA · Orthopedic Physical Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.