Active NPI
Robert Wayne Weatherly, PT
- Physical Therapist
- Lebanon, VA
National Provider Identifier
1972632800
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2305202621
- Practice address
- 395 Highland Dr
Lebanon, VA 24266 - Phone
- (276) 889-4090
- NPI assigned
- Mar 5, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2305202621 | VA | Primary |
Addresses
Primary practice location
395 Highland Dr
Lebanon, VA 24266
Mailing address
10 Woodland Dr
Bristol, VA 24201-2747
Phone (276) 466-1978
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4979711 | Medicaid | VA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2305202621 | VA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lebanon Physical Therapy and Rehabilitative Services, LLC | Current | Accepting new patients |
Locations
272 Highland Dr
Lebanon, VA 24266
Phone (276) 889-4090
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Comprehensive Outpatient Rehabilitation Facility (CORF)
- Lebanon, VA
- NPI 1619947678
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1972632800",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 WOODLAND DR",
"city": "BRISTOL",
"state": "VA",
"postal_code": "242012747",
"telephone_number": "276-466-1978"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "395 HIGHLAND DR",
"city": "LEBANON",
"state": "VA",
"postal_code": "24266",
"telephone_number": "276-889-4090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEATHERLY",
"first_name": "ROBERT",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "VA",
"license": "2305202621",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4979711",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lebanon, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.