Healthcare Provider Details

I. General information

NPI: 1841256393
Provider Name (Legal Business Name): JERRY E WEBER PT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERISITY OF NEBRASKA ATHLETIC MEDICINE CENTER OSBORNE ATHLETIC COMPLEX
LINCOLN NE
68588-0128
US

IV. Provider business mailing address

7621 BALDWIN AVE
LINCOLN NE
68507-2922
US

V. Phone/Fax

Practice location:
  • Phone: 402-472-2276
  • Fax: 402-472-2006
Mailing address:
  • Phone: 402-472-2276
  • Fax: 402-472-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number350
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: