Provider Demographics
NPI:1134171036
Name:WEBER, VICTORIA M (PT, ATC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:M
Last Name:WEBER
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:M
Other - Last Name:KERKEMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, ATC
Mailing Address - Street 1:600 OAKMONT LN
Mailing Address - Street 2:STE 600C
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:2053 ZUMBEHL RD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303
Practice Address - Country:US
Practice Address - Phone:636-940-2900
Practice Address - Fax:636-940-2967
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1095622255A2300X
MO100482225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00416236OtherRAILROAD MEDICARE
MO11542783OtherCAQH
MOP00416236OtherRAILROAD MEDICARE