Provider Demographics
NPI:1215604475
Name:WEBER, GAIL HOLGERSON (PT)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:HOLGERSON
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 1:41 ROUTE Y
Mailing Address - Street 2:
Mailing Address - City:GOODMAN
Mailing Address - State:MO
Mailing Address - Zip Code:64843-8182
Mailing Address - Country:US
Mailing Address - Phone:417-529-5243
Mailing Address - Fax:
Practice Address - Street 1:10 STAMPEDE DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:MO
Practice Address - Zip Code:64831-7801
Practice Address - Country:US
Practice Address - Phone:417-845-3321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist