Individual
MRS. MARY KAY LEIBEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3130 GRIMES AVE N, ROBBINSDALE, MN 55422-3217
(763) 450-2737
Mailing address
3130 GRIMES AVE N, ROBBINSDALE, MN 55422-3217
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A1318
MN
Other
Enumeration date
11/02/2009
Last updated
11/02/2009
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