Provider Demographics
NPI:1881804805
Name:WEBER, WENDY (ATC, CSCS)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 GOLF CLUB RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-1529
Mailing Address - Country:US
Mailing Address - Phone:925-685-1230
Mailing Address - Fax:925-685-1772
Practice Address - Street 1:321 GOLF CLUB RD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-1529
Practice Address - Country:US
Practice Address - Phone:925-685-1230
Practice Address - Fax:925-685-1772
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer