MEDICARE: PETER IHRKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2017043237	MO

General Provider Information

NPI Number	:	1538669791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER IHRKE

Provider Business Mailing Address
First Line	:	3645 PINE HOLLOW PL
Second Line	:
City	:	STILLWATER
State	:	MN
Zip	:	55082-3456
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3645 PINE HOLLOW PL
Second Line	:
City	:	STILLWATER
State	:	MN
Zip	:	55082-3456
Country	:	US
Telephone Number	:	651-357-2698
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2018
Last Update Date	:	02/14/2018

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Directions to “ PETER IHRKE ” Practice Location

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