Provider Demographics
NPI:1497873889
Name:WEBER, KATHRYN A (PT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
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 1:1319 W BASELINE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-9307
Mailing Address - Country:US
Mailing Address - Phone:303-665-8747
Mailing Address - Fax:303-926-0184
Practice Address - Street 1:1319 W BASELINE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-9307
Practice Address - Country:US
Practice Address - Phone:303-665-8747
Practice Address - Fax:303-926-0184
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6345225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO802275Medicare PIN