Provider Demographics
NPI:1306150826
Name:WIEBELHAUS, THERESE MONICA (MT)
Entity type:Individual
Prefix:MISS
First Name:THERESE
Middle Name:MONICA
Last Name:WIEBELHAUS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 CREDIT RIVER RD SE
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-2557
Mailing Address - Country:US
Mailing Address - Phone:763-354-9778
Mailing Address - Fax:
Practice Address - Street 1:4900 CREDIT RIVER RD SE
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-2557
Practice Address - Country:US
Practice Address - Phone:763-354-9778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist