Provider Demographics
NPI:1114716404
Name:GRIECHEN, MIKAELA (DPT, PT)
Entity type:Individual
Prefix:
First Name:MIKAELA
Middle Name:
Last Name:GRIECHEN
Suffix:
Gender:
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 29TH AVE W
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-7878
Mailing Address - Country:US
Mailing Address - Phone:530-310-8065
Mailing Address - Fax:
Practice Address - Street 1:123 3RD ST N
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4507
Practice Address - Country:US
Practice Address - Phone:701-642-7047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist