Provider Demographics
NPI:1407811367
Name:WEBER, CAROLYN R (PT)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:R
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 1:375 WALLER RD
Mailing Address - Street 2:
Mailing Address - City:GEORGIA
Mailing Address - State:VT
Mailing Address - Zip Code:05468
Mailing Address - Country:US
Mailing Address - Phone:802-527-2443
Mailing Address - Fax:
Practice Address - Street 1:150 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:SOUTH BIRLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403
Practice Address - Country:US
Practice Address - Phone:802-862-4670
Practice Address - Fax:802-862-4431
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400003280225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2191Medicaid
VT5666869001OtherCIGNA
VTOVN2191Medicaid