=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619450475
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW J WEBER PT, DPT, LAT, ATC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2018
-----------------------------------------------------
Last Update Date | 12/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1153 E 3900 S
-----------------------------------------------------
City | MILL CREEK
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-262-6331
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1153 E 3900 S
-----------------------------------------------------
City | MILL CREEK
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-262-6331
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 9467244-2401
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | 9467244-4801
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------