Provider Demographics
NPI:1609946623
Name:WEIKLE, KARI MAELAND
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:MAELAND
Last Name:WEIKLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARI
Other - Middle Name:MAELAND
Other - Last Name:WEIKLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPT
Mailing Address - Street 1:68278 440TH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:MN
Mailing Address - Zip Code:55332-3022
Mailing Address - Country:US
Mailing Address - Phone:507-426-7855
Mailing Address - Fax:
Practice Address - Street 1:300 SOUTH PARK ST.
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:MN
Practice Address - Zip Code:55332
Practice Address - Country:US
Practice Address - Phone:507-426-7228
Practice Address - Fax:507-426-8257
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5291225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist