Provider Demographics
NPI:1740475441
Name:WEBER, RICHARD G (PT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:G
Last Name:WEBER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7114 GALEN DR W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8658
Mailing Address - Country:US
Mailing Address - Phone:317-272-9700
Mailing Address - Fax:317-272-9200
Practice Address - Street 1:7114 GALEN DR W
Practice Address - Street 2:SUITE 200
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8658
Practice Address - Country:US
Practice Address - Phone:317-272-9700
Practice Address - Fax:317-272-9200
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05000640A261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN179900Medicare PIN