MEDICARE: MR. TOM JOSEPH WEBER PT, MPT, OCS

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	2251X0800X	Orthopedic Physical Therapist	06419	LA

General Provider Information

NPI Number	:	1932290848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TOM JOSEPH WEBER PT, MPT, OCS

Provider Business Mailing Address
First Line	:	311 VETERANS BLVD
Second Line	:	SUITE A
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-4722
Country	:	US
Telephone Number	:	225-667-6598
Fax Number	:	225-664-8167

Provider Business Practice Location Address
First Line	:	311 VETERANS BLVD
Second Line	:	SUITE A
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-4722
Country	:	US
Telephone Number	:	225-667-6598
Fax Number	:	225-664-8167

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	09/06/2007

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