MEDICARE: PHYLLIS C. WEBER L.AC.

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	171100000X	Acupuncturist	771	FL

General Provider Information

NPI Number	:	1518055201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS C. WEBER L.AC.

Provider Business Mailing Address
First Line	:	6300 CORPORATE CT STE 104
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3513
Country	:	US
Telephone Number	:	239-936-4199
Fax Number	:

Provider Business Practice Location Address
First Line	:	6300 CORPORATE CT STE 104
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3513
Country	:	US
Telephone Number	:	239-936-4199
Fax Number	:

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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