Healthcare Provider Details

I. General information

NPI: 1700961042
Provider Name (Legal Business Name): WIEBER PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1961 CARDINAL LN SUITE A
FARIBAULT MN
55021-4353
US

IV. Provider business mailing address

1961 CARDINAL LN SUITE A
FARIBAULT MN
55021-4353
US

V. Phone/Fax

Practice location:
  • Phone: 507-333-2986
  • Fax:
Mailing address:
  • Phone: 507-333-2986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5231
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number102310
License Number StateMN

VIII. Authorized Official

Name: MICHELLE SCHULTE WIEBER
Title or Position: OWNER
Credential:
Phone: 507-333-2986