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General NPI Number Information
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NPI Number | 1205588183
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Entity Type | Individual
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Provider Name | MINDY KRIEGBAUM LMT
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Gender | Female
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Dates
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Enumeration Date | 01/22/2022
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 4080 MARSHALL RD STE 101
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City | KETTERING
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State | OH
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Zip | 45429-5157
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Country | US
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Telephone | 937-241-5173
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Fax | 937-567-0716
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Provider Business Mailing Address
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Address Line | 4080 MARSHALL RD STE 101
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City | KETTERING
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State | OH
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Zip | 45429-5157
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Country | US
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Telephone | 937-241-5173
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Fax | 937-567-0716
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 33.023871
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License Number State | OH
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