Provider Demographics
NPI:1407868219
Name:KLOIBER, MARYELLEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARYELLEN
Middle Name:
Last Name:KLOIBER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:MARYELLEN
Other - Middle Name:
Other - Last Name:MORIARTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1942 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-2724
Mailing Address - Country:US
Mailing Address - Phone:920-458-1942
Mailing Address - Fax:
Practice Address - Street 1:1942 N 7TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-2724
Practice Address - Country:US
Practice Address - Phone:920-458-1942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1602-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist