MEDICARE: LORA A WEBER PT

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	070014216	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00751931	OTHER	IL	MEDICARE GROUP MEMBER PTAN

General Provider Information

NPI Number	:	1659331809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORA A WEBER PT

Provider Business Mailing Address
First Line	:	525C S SWEETBRIAR DR
Second Line	:
City	:	CHILLICOTHEE
State	:	IL
Zip	:	61523-2229
Country	:	US
Telephone Number	:	309-274-6314
Fax Number	:	309-274-4100

Provider Business Practice Location Address
First Line	:	525C S SWEETBRIAR DR
Second Line	:
City	:	CHILLICOTHEE
State	:	IL
Zip	:	61523-2229
Country	:	US
Telephone Number	:	309-274-6314
Fax Number	:	309-274-4100

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	10/27/2009

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Directions to “ LORA A WEBER PT” Practice Location

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