Provider Demographics
NPI:1104586841
Name:FREIBOTH, HANNAH LEE (DPT)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:LEE
Last Name:FREIBOTH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 472
Mailing Address - Street 2:
Mailing Address - City:MEDORA
Mailing Address - State:ND
Mailing Address - Zip Code:58645-0472
Mailing Address - Country:US
Mailing Address - Phone:701-872-6724
Mailing Address - Fax:
Practice Address - Street 1:1462 I94 BUSINESS LOOP E UNIT 1
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-6419
Practice Address - Country:US
Practice Address - Phone:701-872-6724
Practice Address - Fax:701-353-2073
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist