Individual
MARY LARSON WEBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
1119 N WISCONSIN ST, PORT WASHINGTON, WI 53074-1209
(262) 285-5892
Mailing address
11312 N BOBOLINK LN, MEQUON, WI 53092-3005
(262) 242-7836
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4508-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40229300
—
WI
Enumeration date
05/09/2007
Last updated
12/05/2008
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