Individual
CAROLYN FRANCES WEBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
754 WASHINGTON AVE, POCATELLO, ID 83201-3748
(505) 412-8384
(208) 908-7115
Mailing address
1800 FLANDRO DR, STE 190, POCATELLO, ID 83202-4940
(208) 233-2248
(208) 233-0219
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
PT-6101
ID
225100000X
Physical Therapist
Primary
PT-6101
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT-6101
STATE LICENSE
ID
Enumeration date
08/13/2019
Last updated
09/15/2020
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