Provider Demographics
NPI:1336795673
Name:WEBER, CAROLYN FRANCES (DPT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:FRANCES
Last Name:WEBER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
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Mailing Address - Street 1:1800 FLANDRO DR
Mailing Address - Street 2:STE 190
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83202-4940
Mailing Address - Country:US
Mailing Address - Phone:208-233-2248
Mailing Address - Fax:208-233-0219
Practice Address - Street 1:754 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-3748
Practice Address - Country:US
Practice Address - Phone:505-412-8384
Practice Address - Fax:208-908-7115
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDPT-6101208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDPT-6101OtherSTATE LICENSE