Provider Demographics
NPI:1750574257
Name:FEESER, KRISTEN NOELLE (MPT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:NOELLE
Last Name:FEESER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-1410
Mailing Address - Country:US
Mailing Address - Phone:605-722-8181
Mailing Address - Fax:
Practice Address - Street 1:1333 N 5TH ST
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-1410
Practice Address - Country:US
Practice Address - Phone:605-722-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0527225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist