Provider Demographics
NPI:1497843999
Name:WEBER, MARY ALICE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ALICE
Last Name:WEBER
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7518 KING RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37062-8313
Mailing Address - Country:US
Mailing Address - Phone:615-799-2875
Mailing Address - Fax:615-799-2875
Practice Address - Street 1:812 N CHARLOTTE ST
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-1009
Practice Address - Country:US
Practice Address - Phone:615-446-8046
Practice Address - Fax:615-441-3138
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2013-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNPT0000000193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist