Provider Demographics
NPI:1801373790
Name:WEBER, MATTHEW (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:WEBER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 SHAKESPEARE ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-3427
Mailing Address - Country:US
Mailing Address - Phone:937-361-3225
Mailing Address - Fax:
Practice Address - Street 1:4924 CAMPBELL BLVD STE 130A
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-5909
Practice Address - Country:US
Practice Address - Phone:443-442-2810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD270482251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic