MEDICARE: PAMELA L. 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	3564-024	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K400284168	OTHER	WI	MEDICARE PTAN

General Provider Information

NPI Number	:	1992714638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA L. WEBER PT

Provider Business Mailing Address
First Line	:	PO BOX 3497
Second Line	:
City	:	STURTEVANT
State	:	WI
Zip	:	53177-0300
Country	:	US
Telephone Number	:	877-552-2996
Fax Number	:	866-245-8064

Provider Business Practice Location Address
First Line	:	10342 DYNO DR
Second Line	:	STE 2
City	:	HAYWARD
State	:	WI
Zip	:	54843-6150
Country	:	US
Telephone Number	:	715-699-1371
Fax Number	:	866-245-8064

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	05/23/2016

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Directions to “ PAMELA L. WEBER PT” Practice Location

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