Provider Demographics
NPI:1124377130
Name:WEBER, JONATHAN ROBERT (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ROBERT
Last Name:WEBER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 S FRASER ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4509
Mailing Address - Country:US
Mailing Address - Phone:303-745-9222
Mailing Address - Fax:
Practice Address - Street 1:2222 S FRASER ST
Practice Address - Street 2:UNIT 2
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4509
Practice Address - Country:US
Practice Address - Phone:303-745-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011818225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist