Provider Demographics
NPI:1700964921
Name:WEBER, VIVIAN ANN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:ANN
Last Name:WEBER
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 S WINTERBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-2204
Mailing Address - Country:US
Mailing Address - Phone:913-764-5817
Mailing Address - Fax:
Practice Address - Street 1:1208 S WINTERBROOKE DR
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-2204
Practice Address - Country:US
Practice Address - Phone:913-764-5817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-00934225100000X
MOR0875225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist