Mary Larson Weber, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

4508-024 Issued in WI

Practice address

1119 N Wisconsin St
Port Washington, WI 53074-1209

Phone

(262) 285-5892

NPI assigned

May 9, 2007

Last updated

Dec 5, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228435200000",
    "number": "1740494764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11312 N BOBOLINK LN",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923005",
            "telephone_number": "262-242-7836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1119 N WISCONSIN ST",
            "city": "PORT WASHINGTON",
            "state": "WI",
            "postal_code": "530741209",
            "telephone_number": "262-285-5892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEBER",
        "first_name": "MARY",
        "middle_name": "LARSON",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-09",
        "last_updated": "2008-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "4508-024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40229300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sophia Barbara Voeltz, LPC-IT
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• Carly Wallner
• Ciara Wardenburg, DPT
• Rachel Anne Wasielewski
• Jacqueline Weeden, LCSW
• Elizabeth Noel Wehner
• Brian A Weir, RPH
• Gretel Weiskopf, PTA
• Melissa Wellenstein, LPC

• Physical Therapist in Port Washington, WI
• Providers in Port Washington, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.