Provider Demographics
NPI:1124392626
Name:WEBBER, EDITH EILEEN (LMT)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:EILEEN
Last Name:WEBBER
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 1:10021 SW 182ND CIR
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34432-4429
Mailing Address - Country:US
Mailing Address - Phone:352-875-0903
Mailing Address - Fax:
Practice Address - Street 1:1302 SE 25TH LOOP
Practice Address - Street 2:SUITE 104
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1027
Practice Address - Country:US
Practice Address - Phone:352-620-8885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA65448225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist