Healthcare Provider Details

I. General information

NPI: 1518710219
Provider Name (Legal Business Name): SEAN WEBER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10376 S JORDAN GTWY
SOUTH JORDAN UT
84095-3954
US

IV. Provider business mailing address

343 S 500 E APT 533
SALT LAKE CITY UT
84102-4056
US

V. Phone/Fax

Practice location:
  • Phone: 801-816-0332
  • Fax:
Mailing address:
  • Phone: 801-816-0332
  • Fax: 801-816-0331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number14305841-8906
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: