MEDICARE: KIRSTEN JANE FAESSLER MPT

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	1483	NE

General Provider Information

NPI Number	:	1538016365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN JANE FAESSLER MPT

Provider Business Mailing Address
First Line	:	624 W LEOTA ST
Second Line	:
City	:	NORTH PLATTE
State	:	NE
Zip	:	69101-6532
Country	:	US
Telephone Number	:	308-534-5590
Fax Number	:	308-534-5570

Provider Business Practice Location Address
First Line	:	319 E FRANCIS ST OFC 100
Second Line	:
City	:	NORTH PLATTE
State	:	NE
Zip	:	69101-7631
Country	:	US
Telephone Number	:	308-534-5590
Fax Number	:	308-534-5570

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

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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