Healthcare Provider Details

I. General information

NPI: 1609946623
Provider Name (Legal Business Name): KARI MAELAND WEIKLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KARI MAELAND WEIKLE RPT

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SOUTH PARK ST.
FAIRFAX MN
55332
US

IV. Provider business mailing address

68278 440TH ST
FAIRFAX MN
55332-3022
US

V. Phone/Fax

Practice location:
  • Phone: 507-426-7228
  • Fax: 507-426-8257
Mailing address:
  • Phone: 507-426-7855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5291
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: