Provider Demographics
NPI:1922276369
Name:WEBER, DEIRDRE POTTLE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:DEIRDRE
Middle Name:POTTLE
Last Name:WEBER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4587 APPLE WAY
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1740
Mailing Address - Country:US
Mailing Address - Phone:303-447-3727
Mailing Address - Fax:
Practice Address - Street 1:4587 APPLE WAY
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1740
Practice Address - Country:US
Practice Address - Phone:303-447-3727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7581225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist