Individual
HEATHER A KIEBKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
1245 WASHINGTON AVE, DETROIT LAKES, MN 56501
(218) 846-2000
Mailing address
2510 CHERRY HILL DR, DETROIT LAKES, MN 56501-8063
(701) 640-8645
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6245
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00F70SO
MNBS #
ND
05
—
1144265513
—
MN
01
—
17701
NDBS #
ND
01
—
17702
NDBS #
ND
01
—
18166
NDBS #
MN
05
—
58998
—
ND
01
—
6401666
MEDICA #
ND
01
—
6404053
MEDICA #
ND
01
—
72D46SO
MNBS #
MN
01
—
74G75SO
MNBS #
ND
01
—
778237
AMERICA'S PPO/ARAZ #
ND
01
—
DA9011040527
PREFERRED ONE #
ND
01
—
HP38646
HEALTHPARTNERS #
ND
01
—
ND400023
LHS #
ND
Enumeration date
06/18/2006
Last updated
02/14/2022
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