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NPI Code Detail

MEDICARE: KIMBERLY WIESEN M.H.S., P. T.

MEDICARE: KIMBERLY WIESEN M.H.S., P. T.
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
1225100000XPhysical Therapist499NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841348224
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY WIESEN M.H.S., P. T.
Provider Business Mailing Address
First Line : 1636 PALMALES CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-3238
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2625 E SAINT LOUIS AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89104-4200
Country : US
Telephone Number : 702-799-7463
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2007
Last Update Date : 12/07/2009

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