Provider Demographics
NPI:1992875843
Name:WEBER THERAPY ASSOCIATES, INC.
Entity type:Organization
Organization Name:WEBER THERAPY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:MED CCC SLP
Authorized Official - Phone:912-537-6130
Mailing Address - Street 1:302 DURDEN ST
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-4606
Mailing Address - Country:US
Mailing Address - Phone:912-537-6130
Mailing Address - Fax:912-537-6130
Practice Address - Street 1:302 DURDEN ST
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-4606
Practice Address - Country:US
Practice Address - Phone:912-537-6130
Practice Address - Fax:912-537-6130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003625235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00699663CMedicaid