Provider Demographics
NPI:1437161239
Name:WEBER, EDWARD GLENN (MPT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:GLENN
Last Name:WEBER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 36TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-1005
Mailing Address - Country:US
Mailing Address - Phone:304-917-3660
Mailing Address - Fax:304-917-3674
Practice Address - Street 1:800 GRAND CENTRAL MALL
Practice Address - Street 2:SUITE 1
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-4100
Practice Address - Country:US
Practice Address - Phone:304-865-6777
Practice Address - Fax:304-865-6780
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001333225100000X
OHPT006713225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2702614Medicaid
WV7305220000Medicaid
P00123835OtherRAILROAD MEDICARE
4128813Medicare PIN