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General NPI Number Information
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NPI Number | 1750255345
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Entity Type | Individual
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Provider Name | JONATHAN WEBER
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Gender | Male
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 152 MOUNTAIN RD
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City | SUFFIELD
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State | CT
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Zip | 06078-2058
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Country | US
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Telephone | 413-789-0752
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Fax |
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Provider Business Mailing Address
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Address Line | 38 MOHAWK DR
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City | AVERILL PARK
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State | NY
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Zip | 12018-6014
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 15076
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License Number State | CT
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