Jordan Weaver

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT032499 Issued in PA

Practice address

920 S Spruce St
Elizabethtown, PA 17022-2758

Phone

(717) 415-0313

NPI assigned

Aug 3, 2024

Last updated

Aug 3, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Legacy Physical Therapy LLCGroup PAC ID 0840649950, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Legacy Physical Therapy LLC

  • Physical Therapist
  • Elizabethtown, PA
  • NPI 1093494197
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1722643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722643200000",
    "number": "1770313975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 S SPRUCE ST",
            "city": "ELIZABETHTOWN",
            "state": "PA",
            "postal_code": "170222758",
            "telephone_number": "717-415-0313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 S SPRUCE ST",
            "city": "ELIZABETHTOWN",
            "state": "PA",
            "postal_code": "170222758",
            "telephone_number": "717-415-0313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEAVER",
        "first_name": "JORDAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-03",
        "last_updated": "2024-08-03",
        "certification_date": "2024-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT032499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Voutsas
• Ruth Anne Wagner, M.D.
• Kimberly A Walheim, LPC
• Kathleen Marie Warner, LMSW
• Christopher Michael Washington, M.D.
• Weis Markets Inc (Weis Pharmacy)
• Madeleine Wenger, DPT
• White Family Dental - Elizabethtown, PLLC
• White Family Dental - Masonic Village LLC (White Family Dental)
• White Family Dental - Masonic Village PLLC

• Physical Therapist in Elizabethtown, PA
• Providers in Elizabethtown, PA by specialty
• Physical Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.