Provider Demographics
NPI:1184199952
Name:WEBER, JESSE THOMAS (ATS)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:THOMAS
Last Name:WEBER
Suffix:
Gender:M
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4359
Mailing Address - Country:US
Mailing Address - Phone:605-850-9053
Mailing Address - Fax:
Practice Address - Street 1:620 N 18TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4359
Practice Address - Country:US
Practice Address - Phone:605-850-9053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer