Provider Demographics
NPI:1437870698
Name:WEBBER THERAPY SERVICES
Entity Type:Organization
Organization Name:WEBBER THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBBER
Authorized Official - Suffix:
Authorized Official - Credentials:MED CCC-SLP
Authorized Official - Phone:229-686-0847
Mailing Address - Street 1:430 KEN HOLYOAK RD
Mailing Address - Street 2:
Mailing Address - City:ALAPAHA
Mailing Address - State:GA
Mailing Address - Zip Code:31622-2224
Mailing Address - Country:US
Mailing Address - Phone:229-686-0847
Mailing Address - Fax:229-532-3926
Practice Address - Street 1:430 KEN HOLYOAK RD
Practice Address - Street 2:
Practice Address - City:ALAPAHA
Practice Address - State:GA
Practice Address - Zip Code:31622-2224
Practice Address - Country:US
Practice Address - Phone:229-686-0847
Practice Address - Fax:229-532-3926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003217827AMedicaid