Provider Demographics
NPI:1770101966
Name:WEBER PHYSICAL THERAPY AND WELLNESS, PLLC
Entity type:Organization
Organization Name:WEBER PHYSICAL THERAPY AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:505-412-8384
Mailing Address - Street 1:580 FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-3808
Mailing Address - Country:US
Mailing Address - Phone:505-412-8384
Mailing Address - Fax:208-908-7115
Practice Address - Street 1:580 FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-3808
Practice Address - Country:US
Practice Address - Phone:505-412-8384
Practice Address - Fax:208-908-7115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty