Provider Demographics
NPI:1790709673
Name:HIEB, MARCUS (PT)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:HIEB
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 TACOMA AVE
Mailing Address - Street 2:SUTIE 500
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-7036
Mailing Address - Country:US
Mailing Address - Phone:701-751-3001
Mailing Address - Fax:701-751-3089
Practice Address - Street 1:1000 TACOMA AVE
Practice Address - Street 2:SUTIE 500
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-7036
Practice Address - Country:US
Practice Address - Phone:701-751-3001
Practice Address - Fax:701-751-3089
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1551225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND55714Medicaid