Provider Demographics
NPI:1952403271
Name:HILDEBRAND, CARRIE RONNETTE (PT)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:RONNETTE
Last Name:HILDEBRAND
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 9TH ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-4809
Mailing Address - Country:US
Mailing Address - Phone:620-282-4825
Mailing Address - Fax:620-205-1206
Practice Address - Street 1:2817 9TH ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-4809
Practice Address - Country:US
Practice Address - Phone:620-282-4825
Practice Address - Fax:620-205-1206
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02642225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100643470BMedicaid
KS17-6565Medicare ID - Type Unspecified