Provider Demographics
NPI:1740439090
Name:WEBER, COURTNEY WALDRON (LPT)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:WALDRON
Last Name:WEBER
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 SWAN LAKE DR APT 106
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-8226
Mailing Address - Country:US
Mailing Address - Phone:540-750-0686
Mailing Address - Fax:
Practice Address - Street 1:5301 PROVIDENCE RD
Practice Address - Street 2:SUITE 80
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4128
Practice Address - Country:US
Practice Address - Phone:757-467-4604
Practice Address - Fax:757-467-2716
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 27198225100000X
CO11376225100000X
VA2305205543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist