MEDICARE: BRENT WEBER DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1502	ND

General Provider Information

NPI Number	:	1043462302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT WEBER DPT

Provider Business Mailing Address
First Line	:	405 N BROADWAY ST
Second Line	:
City	:	LINTON
State	:	ND
Zip	:	58552-7024
Country	:	US
Telephone Number	:	701-321-2150
Fax Number	:

Provider Business Practice Location Address
First Line	:	2004 TWIN CITY DR
Second Line	:
City	:	MANDAN
State	:	ND
Zip	:	58554-3820
Country	:	US
Telephone Number	:	701-667-0745
Fax Number	:	701-667-0707

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2008
Last Update Date	:	10/17/2008

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Directions to “ BRENT WEBER DPT” Practice Location

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