Provider Demographics
NPI:1639104524
Name:WEBER, FRIEDRICH J JR (PT)
Entity Type:Individual
Prefix:
First Name:FRIEDRICH
Middle Name:J
Last Name:WEBER
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:FRED
Other - Middle Name:
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1233 N NORTHWOOD CENTER CT STE 101
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6190
Mailing Address - Country:US
Mailing Address - Phone:208-457-4211
Mailing Address - Fax:208-773-1473
Practice Address - Street 1:1233 N NORTHWOOD CENTER CT STE 101
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-6190
Practice Address - Country:US
Practice Address - Phone:208-457-4211
Practice Address - Fax:208-773-1473
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-6872251S0007X, 2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1650962OtherPTAN