Provider Demographics
NPI:1336370683
Name:WEBSTER, RAYMON STEPHEN IV (DPT)
Entity Type:Individual
Prefix:MR
First Name:RAYMON
Middle Name:STEPHEN
Last Name:WEBSTER
Suffix:IV
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21A RAILROAD AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-5931
Mailing Address - Country:US
Mailing Address - Phone:518-650-6962
Mailing Address - Fax:
Practice Address - Street 1:21A RAILROAD AVE
Practice Address - Street 2:UNIT B
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-5931
Practice Address - Country:US
Practice Address - Phone:518-650-6962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037709-01261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty