Provider Demographics
NPI:1922438779
Name:WEBBER, JERRY (LAT, ATC, PTA)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:WEBBER
Suffix:
Gender:M
Credentials:LAT, ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 ELIZABETHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-9323
Mailing Address - Country:US
Mailing Address - Phone:717-835-0700
Mailing Address - Fax:717-835-0702
Practice Address - Street 1:3003 ELIZABETHTOWN RD
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-9323
Practice Address - Country:US
Practice Address - Phone:717-835-0700
Practice Address - Fax:717-835-0702
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART00167A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer