Provider Demographics
NPI:1477528222
Name:SCHULTE-WIEBER, MICHELLE (ATC, LPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SCHULTE-WIEBER
Suffix:
Gender:F
Credentials:ATC, LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1961 CARDINAL LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-4353
Mailing Address - Country:US
Mailing Address - Phone:507-333-2986
Mailing Address - Fax:507-333-2918
Practice Address - Street 1:1961 CARDINAL LN
Practice Address - Street 2:SUITE A
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-4353
Practice Address - Country:US
Practice Address - Phone:507-333-2986
Practice Address - Fax:507-333-2918
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN305224900Medicaid
MN305224900Medicaid