Individual
NICHOLAS WEBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
4800 MEXICO RD, SUITE 104, SAINT PETERS, MO 63376-1666
(636) 939-9540
(636) 939-9886
Mailing address
607 DEWEY AVE NW, STE 300, GRAND RAPIDS, MI 49504-7335
(616) 356-5000
(616) 356-5001
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2005017285
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11543068
CAQH
MO
01
—
P00388087
RAILROAD MEDICARE
MO
Enumeration date
05/22/2006
Last updated
05/12/2016
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