1477662989 NPI number — MOLLY A WEBER PT, LAT, ATC

Table of content: MOLLY A WEBER PT, LAT, ATC (NPI 1477662989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477662989 NPI number — MOLLY A WEBER PT, LAT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEBER
Provider First Name:
MOLLY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, LAT, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477662989
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 26168
Provider Second Line Business Mailing Address:
UNC GREENSBORO ATHLETICS
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27402-6168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-334-5925
Provider Business Mailing Address Fax Number:
336-256-0407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1408 WALKER AVE.
Provider Second Line Business Practice Location Address:
HHP ROOM 136
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-334-5925
Provider Business Practice Location Address Fax Number:
336-256-0407
Provider Enumeration Date:
08/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  9380 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PT21570 . This is a "LICENSE #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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