Provider Demographics
NPI:1871642819
Name:WEBER, ALBERTO IVAN (PTA)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:IVAN
Last Name:WEBER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 N LEE TREVINO DR
Mailing Address - Street 2:SUITE 700
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-4127
Mailing Address - Country:US
Mailing Address - Phone:915-593-3787
Mailing Address - Fax:915-590-9165
Practice Address - Street 1:1891 N LEE TREVINO DR
Practice Address - Street 2:SUITE 700
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4127
Practice Address - Country:US
Practice Address - Phone:915-593-3787
Practice Address - Fax:915-590-9165
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2047983225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX456749Medicare ID - Type Unspecified