Healthcare Provider Details

I. General information

NPI: 1598951774
Provider Name (Legal Business Name): MIEKE HAECK MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S ALLEN ST STE 103B
STATE COLLEGE PA
16801-4847
US

IV. Provider business mailing address

320 ROLLING RIDGE DR STE 203
STATE COLLEGE PA
16801-7641
US

V. Phone/Fax

Practice location:
  • Phone: 814-808-7232
  • Fax: 814-470-4927
Mailing address:
  • Phone: 814-808-7232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT021044
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number027159
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT021044
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: