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NPI Code Detail

MEDICARE: SHANE WEBER PTA

MEDICARE: SHANE WEBER PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy AssistantPTA21756FL

General Provider Information

NPI Number : 1326522038
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANE WEBER PTA
Provider Business Mailing Address
First Line : 11826 BROOKSIDE DR
Second Line :
City : LAKEWOOD RANCH
State : FL
Zip : 34211-4527
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1902 59TH ST W
Second Line :
City : BRADENTON
State : FL
Zip : 34209-4602
Country : US
Telephone Number : 941-761-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2018
Last Update Date : 09/18/2018

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Directions to “ SHANE WEBER PTA” Practice Location

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