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General NPI Number Information
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NPI Number | 1194239152
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Entity Type | Individual
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Provider Name | MAXINE WEBER MS, ATC, CSCS
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Gender | Female
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Dates
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Enumeration Date | 11/28/2017
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 650 JOEL DR
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City | FORT CAMPBELL
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State | KY
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Zip | 42223-5318
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Country | US
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Telephone | 973-459-9937
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Fax |
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Provider Business Mailing Address
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Address Line | 3301 ROYSTER LN APT 901
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City | CLARKSVILLE
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State | TN
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Zip | 37042-7744
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Country | US
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Telephone | 973-459-9937
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RT007088
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License Number State | PA
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