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 1:1514 K 96 HWY
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-3012
Mailing Address - Country:US
Mailing Address - Phone:620-792-7868
Mailing Address - Fax:
Practice Address - Street 1:1514 K 96 HWY
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3012
Practice Address - Country:US
Practice Address - Phone:620-792-7868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
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