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NPI Code Detail

MEDICARE: NICHOLAS WEBER MPT

MEDICARE: NICHOLAS WEBER MPT
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
1225100000XPhysical Therapist2005017285MO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00388087OTHERMORAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111543068OTHERMOCAQH

General Provider Information

NPI Number : 1063466019
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS WEBER MPT
Provider Business Mailing Address
First Line : 607 DEWEY AVE NW
Second Line : STE 300
City : GRAND RAPIDS
State : MI
Zip : 49504-7335
Country : US
Telephone Number : 616-356-5000
Fax Number : 616-356-5001
Provider Business Practice Location Address
First Line : 4800 MEXICO RD
Second Line : SUITE 104
City : SAINT PETERS
State : MO
Zip : 63376-1666
Country : US
Telephone Number : 636-939-9540
Fax Number : 636-939-9886
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2006
Last Update Date : 05/12/2016

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Practice Location Address:
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1548229321 — JULIE FERNANDEZ PT
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1417908203 — ELIZABETH KRUEGER P.T.
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Practice Fax: 636-922-0818
1417909052 — DIANE KEEVEN P. T.
Practice Location Address:
4800 MEXICO RD , SUITE 104
ST PETERS, MO
63376-1666
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1750334488 — JENNIFER N RUTKOWSKI PT
Practice Location Address:
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1427002476 — CHARLES B MCDONNELL PT, CHT
Practice Location Address:
4800 MEXICO RD , SUITE 104
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63376-1666
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Practice Fax: 636-939-9886

Directions to “ NICHOLAS WEBER MPT” Practice Location

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