Provider Demographics
NPI:1043462302
Name:WEBER, BRENT (DPT)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:WEBER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:ND
Mailing Address - Zip Code:58552-7024
Mailing Address - Country:US
Mailing Address - Phone:701-321-2150
Mailing Address - Fax:
Practice Address - Street 1:2004 TWIN CITY DR
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-3820
Practice Address - Country:US
Practice Address - Phone:701-667-0745
Practice Address - Fax:701-667-0707
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1502225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist