Provider Demographics
NPI:1326208596
Name:WEBER, THERESA FITZGERALD (PT)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:FITZGERALD
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 1:133 CHINQUAPIN CT
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1125
Mailing Address - Country:US
Mailing Address - Phone:510-799-6979
Mailing Address - Fax:
Practice Address - Street 1:2160 APPIAN WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2576
Practice Address - Country:US
Practice Address - Phone:511-072-4124
Practice Address - Fax:510-724-5720
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14354225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist