Provider Demographics
NPI:1912354705
Name:WEBER, SAMANTHA (MSED, ATC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:MSED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4031 S 91ST PL
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-2225
Mailing Address - Country:US
Mailing Address - Phone:414-828-5000
Mailing Address - Fax:
Practice Address - Street 1:4031 S 91ST PL
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-2225
Practice Address - Country:US
Practice Address - Phone:414-828-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-21
Last Update Date:2016-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer