Healthcare Provider Details

I. General information

NPI: 1619450475
Provider Name (Legal Business Name): MATTHEW J WEBER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date: 02/25/2020
Reactivation Date: 03/31/2020

III. Provider practice location address

1153 EAST 3900 SOUTH
SALT LAKE CITY UT
84124-1201
US

IV. Provider business mailing address

PO BOX 711185
SALT LAKE CITY UT
84171-1185
US

V. Phone/Fax

Practice location:
  • Phone: 801-262-6331
  • Fax: 801-262-3372
Mailing address:
  • Phone: 801-262-6331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9467244-2401
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number9467244-4801
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: