Provider Demographics
NPI:1912052119
Name:WEBER, LISA ANNE (PT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANNE
Last Name:WEBER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 FLORIN ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3501
Mailing Address - Country:US
Mailing Address - Phone:916-395-0625
Mailing Address - Fax:916-395-7648
Practice Address - Street 1:902 FLORIN ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3501
Practice Address - Country:US
Practice Address - Phone:916-395-0625
Practice Address - Fax:916-395-7648
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12326225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPT123260Medicare ID - Type Unspecified