Provider Demographics
NPI:1144489873
Name:WEBER, BEVERLY MARIE (PTA)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:MARIE
Last Name:WEBER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:BEVELRY
Other - Middle Name:MARIE
Other - Last Name:GUYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:RR 2 BOX 208
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-9664
Mailing Address - Country:US
Mailing Address - Phone:812-847-9675
Mailing Address - Fax:812-847-4708
Practice Address - Street 1:RR 2 BOX 208
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-9664
Practice Address - Country:US
Practice Address - Phone:812-847-9675
Practice Address - Fax:812-847-4708
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06001039225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant