Provider Demographics
NPI:1679309934
Name:WEBER, AMY C (LMT)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:C
Last Name:WEBER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 82
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:TX
Mailing Address - Zip Code:75422
Mailing Address - Country:US
Mailing Address - Phone:469-510-6000
Mailing Address - Fax:
Practice Address - Street 1:1221 ARISTA DRIVE, SUITE 200
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032
Practice Address - Country:US
Practice Address - Phone:214-686-3650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT046620225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist