Healthcare Provider Details

I. General information

NPI: 1134171036
Provider Name (Legal Business Name): VICTORIA M WEBER PT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA M KERKEMEYER PT, ATC

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2053 ZUMBEHL RD
SAINT CHARLES MO
63303
US

IV. Provider business mailing address

600 OAKMONT LN STE 600C
WESTMONT IL
60559-5548
US

V. Phone/Fax

Practice location:
  • Phone: 636-940-2900
  • Fax: 636-940-2967
Mailing address:
  • Phone: 630-575-1980
  • Fax: 630-928-5080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number100482
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number109562
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: