Healthcare Provider Details

I. General information

NPI: 1093902116
Provider Name (Legal Business Name): MELINDA RENEE WEBER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 W NORTHWOOD CENTER CT SUITE B
COEUR D ALENE ID
83814-4944
US

IV. Provider business mailing address

PO BOX 758
POST FALLS ID
83877-0758
US

V. Phone/Fax

Practice location:
  • Phone: 208-665-7055
  • Fax: 208-665-7093
Mailing address:
  • Phone: 208-773-6400
  • Fax: 208-773-6800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-643
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: