Provider Demographics
NPI:1821835612
Name:WEBER, SHELLEY KAY (LMT)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:KAY
Last Name:WEBER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 KENNY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2415
Mailing Address - Country:US
Mailing Address - Phone:614-670-4000
Mailing Address - Fax:614-482-4938
Practice Address - Street 1:2929 KENNY RD STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2415
Practice Address - Country:US
Practice Address - Phone:614-670-4000
Practice Address - Fax:614-482-4938
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.018243225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist