Provider Demographics
NPI:1003647355
Name:HILBRANDS, JACK
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:HILBRANDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 US HIGHWAY 59 SE STE A
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-3413
Mailing Address - Country:US
Mailing Address - Phone:218-681-0449
Mailing Address - Fax:218-325-4501
Practice Address - Street 1:1511 US HIGHWAY 59 SE STE A
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-3413
Practice Address - Country:US
Practice Address - Phone:218-681-0449
Practice Address - Fax:218-325-4501
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA3017225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant