Healthcare Provider Details

I. General information

NPI: 1619571445
Provider Name (Legal Business Name): SAMANTHA WEBER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W MILL ST STE 1
EAGLE RIVER WI
54521-8002
US

IV. Provider business mailing address

425 W MILL ST STE 1
EAGLE RIVER WI
54521-8002
US

V. Phone/Fax

Practice location:
  • Phone: 715-891-5011
  • Fax: 715-891-5011
Mailing address:
  • Phone: 480-261-0625
  • Fax: 480-706-7997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15300-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: