Provider Demographics
NPI:1700961042
Name:WIEBER PHYSICAL THERAPY
Entity Type:Organization
Organization Name:WIEBER PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTE WIEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-333-2986
Mailing Address - Street 1:1961 CARDINAL LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-4353
Mailing Address - Country:US
Mailing Address - Phone:507-333-2986
Mailing Address - Fax:
Practice Address - Street 1:1961 CARDINAL LN
Practice Address - Street 2:SUITE A
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-4353
Practice Address - Country:US
Practice Address - Phone:507-333-2986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5231225100000X
MN102310225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN734390600Medicaid
MN8B800WIOtherPROVIDER NUMBER
MN734390600Medicaid
MNC02525Medicare PIN
MN6328960001Medicare NSC