=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528482619
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NORMA KRIEGEL PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2014
-----------------------------------------------------
Last Update Date | 02/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1045 DEARBAUGH AVE
-----------------------------------------------------
City | WAPAKONETA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45895-9245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-738-3422
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4207 SOUTHGATE BLVD
-----------------------------------------------------
City | LIMA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45806-1729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-234-3952
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT.003749
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------