Provider Demographics
NPI:1114628534
Name:WEBER, MARIA L (LMT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:WEBER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 RIDGEWOOD DR STE D
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-2695
Mailing Address - Country:US
Mailing Address - Phone:419-352-0914
Mailing Address - Fax:
Practice Address - Street 1:1234 RIDGEWOOD DR STE D
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2695
Practice Address - Country:US
Practice Address - Phone:419-352-0914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH013212225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist