Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 007189 | KY |
NPI | 1013431584 |
---|---|
Provider Name | Zachary Keaton Weber |
First Address | Louisville, KY 40220-3866 |
Second Address | Louisville, KY 40291-4522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2017 |
Last Update Date | 27/07/2017 |