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General NPI Number Information
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NPI Number | 1144265513
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Entity Type | Individual
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Provider Name | HEATHER A KIEBKE DPT
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Gender | Female
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 02/14/2022
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Provider Practice Location Address
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Address Line | 1245 WASHINGTON AVE
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City | DETROIT LAKES
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State | MN
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Zip | 56501
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Country | US
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Telephone | 218-846-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 2510 CHERRY HILL DR
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City | DETROIT LAKES
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State | MN
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Zip | 56501-8063
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Country | US
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Telephone | 701-640-8645
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 6245
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License Number State | MN
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