Provider Demographics
NPI:1992087746
Name:WEBER, JEREMIAH ARTHUR (DPT)
Entity type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:ARTHUR
Last Name:WEBER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8677 N PORT WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:FOX POINT
Mailing Address - State:WI
Mailing Address - Zip Code:53217-2209
Mailing Address - Country:US
Mailing Address - Phone:414-351-8482
Mailing Address - Fax:
Practice Address - Street 1:8677 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:FOX POINT
Practice Address - State:WI
Practice Address - Zip Code:53217-2209
Practice Address - Country:US
Practice Address - Phone:414-351-8482
Practice Address - Fax:414-351-8483
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11703-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist