Provider Demographics
NPI:1134168313
Name:KRIEG, STEVEN EUGENE (MPT)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:EUGENE
Last Name:KRIEG
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2395 POLE LINE RD
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-7817
Mailing Address - Country:US
Mailing Address - Phone:563-382-4770
Mailing Address - Fax:563-382-4785
Practice Address - Street 1:516 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-2720
Practice Address - Country:US
Practice Address - Phone:563-382-4770
Practice Address - Fax:563-382-4785
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01835225100000X, 2251E1200X, 2251G0304X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomics
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IATN0100OtherJOHN DEERE
IA421470451OtherMAYO
IAF245962OtherMIDLANDS CHOICE
IA44395OtherBLUE CROSS BLUE SHEILD
IA0182782Medicaid
MN8B772KROtherBLUE CROSS BLUE SHEILD
IA650018325Medicare ID - Type UnspecifiedMEDICARE RAILROAD
IAF245962OtherMIDLANDS CHOICE