Healthcare Provider Details

I. General information

NPI: 1184730715
Provider Name (Legal Business Name): EMILY SUSAN WEBER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY SUSAN SCHABERG DPT

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1096 TOM GINNEVER AVE
O FALLON MO
63366-4519
US

IV. Provider business mailing address

625 KENMOOR AVE SE STE 100
GRAND RAPIDS MI
49546-2395
US

V. Phone/Fax

Practice location:
  • Phone: 636-978-5255
  • Fax:
Mailing address:
  • Phone: 616-356-5000
  • Fax: 616-356-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2006023043
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: