Healthcare Provider Details

I. General information

NPI: 1538089123
Provider Name (Legal Business Name): KRISTIN RACHEL MIENTKIEWICZ DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 DUFF AVE
AMES IA
50010-5745
US

IV. Provider business mailing address

1604 JACKSON DR
AMES IA
50010-4438
US

V. Phone/Fax

Practice location:
  • Phone: 515-239-6730
  • Fax:
Mailing address:
  • Phone: 515-450-8033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number085369
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: