Provider Demographics
NPI:1093902116
Name:WEBER, MELINDA RENEE (PT)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:RENEE
Last Name:WEBER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 758
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83877-0758
Mailing Address - Country:US
Mailing Address - Phone:208-773-6400
Mailing Address - Fax:208-773-6800
Practice Address - Street 1:1321 W NORTHWOOD CENTER CT
Practice Address - Street 2:SUITE B
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4944
Practice Address - Country:US
Practice Address - Phone:208-665-7055
Practice Address - Fax:208-665-7093
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist