Provider Demographics
NPI:1689007569
Name:HIEBNER, CARLY (PT)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:HIEBNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N DIERS AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4984
Mailing Address - Country:US
Mailing Address - Phone:308-382-0344
Mailing Address - Fax:308-382-0341
Practice Address - Street 1:905 N CUSTER AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4304
Practice Address - Country:US
Practice Address - Phone:308-398-2170
Practice Address - Fax:308-398-5232
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3246225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist