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General NPI Number Information
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NPI Number | 1386011682
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Entity Type | Organization
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Legal Business Name | WEBER PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 08/22/2015
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Last Update Date | 08/22/2015
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Provider Practice Location Address
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Address Line | 13445 TOSCA CT
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City | ELM GROVE
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State | WI
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Zip | 53122-1343
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Country | US
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Telephone | 612-220-5361
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Fax |
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Provider Business Mailing Address
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Address Line | 13445 TOSCA CT
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City | ELM GROVE
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State | WI
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Zip | 53122-1343
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Country | US
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Telephone | 612-220-5361
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KYLE WEBER
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Credential | PT
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Telephone | 612-220-5361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 12288-24
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License Number State | WI
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