Individual
CRAIG LESLIE THIELEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1731 W RIDGEWAY AVE, SUITE 600, WATERLOO, IA 50701-4594
(319) 833-5900
(319) 833-5901
Mailing address
PO BOX 2758, WATERLOO, IA 50704-2758
(319) 833-5900
(319) 833-5901
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
00910
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0492272
—
IA
01
—
17334
WELLMARK INS PLAN
IA
Enumeration date
05/19/2006
Last updated
07/01/2014
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