Provider Demographics
NPI:1922553619
Name:WEBER, MICAH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MICAH
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 1:9070 W CHEYENNE AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-8934
Mailing Address - Country:US
Mailing Address - Phone:702-655-8535
Mailing Address - Fax:702-656-5863
Practice Address - Street 1:9070 W CHEYENNE AVE
Practice Address - Street 2:STE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-8934
Practice Address - Country:US
Practice Address - Phone:702-655-8535
Practice Address - Fax:702-656-5863
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3427225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist