Provider Demographics
NPI:1184730715
Name:WEBER, EMILY SUSAN (DPT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:SUSAN
Last Name:WEBER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:SUSAN
Other - Last Name:SCHABERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:607 DEWEY AVE NW
Mailing Address - Street 2:STE 300
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-7335
Mailing Address - Country:US
Mailing Address - Phone:616-356-5000
Mailing Address - Fax:616-356-5001
Practice Address - Street 1:2454 W CLAY ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2548
Practice Address - Country:US
Practice Address - Phone:636-949-3926
Practice Address - Fax:636-949-3928
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006023043225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO12325997OtherCAQH
MOP00370064OtherMEDICARE RAILROAD
MO222361643Medicare PIN
MOP00370064OtherMEDICARE RAILROAD