Healthcare Provider Details

I. General information

NPI: 1134938798
Provider Name (Legal Business Name): LISA ANN WEBER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 COBBLE RD
SALISBURY CT
06068-1501
US

IV. Provider business mailing address

405 W HILL RD
NEW HARTFORD CT
06057-2418
US

V. Phone/Fax

Practice location:
  • Phone: 860-435-9851
  • Fax:
Mailing address:
  • Phone: 860-424-1460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number001912
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: