Provider Demographics
NPI:1922088921
Name:WEBER, MARCIE J (PT)
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:J
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 1:15 W UNION ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1464
Mailing Address - Country:US
Mailing Address - Phone:508-881-6750
Mailing Address - Fax:508-881-6760
Practice Address - Street 1:15 W UNION ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MA
Practice Address - Zip Code:01721-1464
Practice Address - Country:US
Practice Address - Phone:508-881-6750
Practice Address - Fax:508-881-6760
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13285225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2779432OtherCIGNA HEALTH PLAN
785968OtherMVP HEALTH CARE
Y37676OtherBLUE CARE ELECT
Y37676OtherBLUE SHIELD HMO BLUE
2779432001OtherCIGNA PAL ID
47830OtherCHILDRENS MEDICAL SECURIT
Y68495OtherMEDICARE B
0396290OtherMEDICAID WELFARE
7793634OtherAETNA US HEALTHCARE
61610OtherFALLON COMMUNITY HEALTH P
MA0396290Medicaid
AA4052OtherHARVARD PILGRIM HEALTHCAR
35481155OtherCIGNA HEALTHSOURCE
Y37676OtherBLUE SHIELD INDEMNITY
7793634OtherAETNA US HEALTHCARE