Provider Demographics
NPI:1255228219
Name:WIEBELHAUS, CHAD (SPT)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:WIEBELHAUS
Suffix:
Gender:M
Credentials:SPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2744 S CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4138
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 W 29TH ST
Practice Address - Street 2:
Practice Address - City:S SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3192
Practice Address - Country:US
Practice Address - Phone:712-635-7796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist