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General NPI Number Information
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NPI Number | 1992821052
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Entity Type | Individual
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Provider Name | PAMELA T WEBER MPT
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Gender | Female
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 10/15/2012
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Provider Practice Location Address
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Address Line | 7250 FRANCE AVE S SUITE 305
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City | EDINA
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State | MN
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Zip | 55435-4305
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Country | US
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Telephone | 952-285-2840
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Fax | 952-285-2830
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Provider Business Mailing Address
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Address Line | 14357 RAVEN ST NW
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City | ANDOVER
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State | MN
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Zip | 55304-3362
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Country | US
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Telephone | 312-371-8393
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 070.010791
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 9197
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License Number State | MN
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