Provider Demographics
NPI:1285949305
Name:WEBER, JENNIFER KRISTEN (PT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KRISTEN
Last Name:WEBER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 GALAHAD DR.
Mailing Address - Street 2:
Mailing Address - City:WELDON SPRING
Mailing Address - State:MO
Mailing Address - Zip Code:63304
Mailing Address - Country:US
Mailing Address - Phone:636-329-0992
Mailing Address - Fax:
Practice Address - Street 1:347 GALAHAD DR
Practice Address - Street 2:
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304-5703
Practice Address - Country:US
Practice Address - Phone:636-329-0992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPT02204225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist