Provider Demographics
NPI:1073950366
Name:WEBER, MILES ANTHONY (DPT)
Entity Type:Individual
Prefix:DR
First Name:MILES
Middle Name:ANTHONY
Last Name:WEBER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 OLDE COUNTRY CIR
Mailing Address - Street 2:
Mailing Address - City:KAUKAUNA
Mailing Address - State:WI
Mailing Address - Zip Code:54130-3766
Mailing Address - Country:US
Mailing Address - Phone:414-238-8349
Mailing Address - Fax:
Practice Address - Street 1:279 N ALTENHOFEN DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8401
Practice Address - Country:US
Practice Address - Phone:920-738-0671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12381-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist