Provider Demographics
NPI:1861597460
Name:WEBER, MARCUS DUFFY (PT)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:DUFFY
Last Name:WEBER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18067-1321
Mailing Address - Country:US
Mailing Address - Phone:610-262-0300
Mailing Address - Fax:610-262-3037
Practice Address - Street 1:2006 CENTER ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18067-1321
Practice Address - Country:US
Practice Address - Phone:610-262-0300
Practice Address - Fax:610-262-3037
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018350225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016806440003Medicaid
PA0016806440003Medicaid