Healthcare Provider Details

I. General information

NPI: 1497011530
Provider Name (Legal Business Name): JOANIE MARIE WEBER P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANIE MARIE JACKSON P.T.

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W HIGHWAY 90
ALPINE TX
79830-3311
US

IV. Provider business mailing address

2525 N GRANDVIEW AVE STE 400
ODESSA TX
79761-1600
US

V. Phone/Fax

Practice location:
  • Phone: 432-837-5918
  • Fax: 432-837-9937
Mailing address:
  • Phone: 432-550-4700
  • Fax: 432-550-4715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1175790
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: