MEDICARE: MARY WIEBERS DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2853	ND

General Provider Information

NPI Number	:	1083542310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY WIEBERS DPT

Provider Business Mailing Address
First Line	:	1000 TACOMA AVE STE 500
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58504-7093
Country	:	US
Telephone Number	:	701-751-3001
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 TACOMA AVE STE 500
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58504-7093
Country	:	US
Telephone Number	:	701-751-3001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2026
Last Update Date	:	05/08/2026

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Directions to “ MARY WIEBERS DPT” Practice Location

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