Provider Demographics
NPI:1699891044
Name:PRIEBE, RUNDI MARIE (DPT)
Entity type:Individual
Prefix:MRS
First Name:RUNDI
Middle Name:MARIE
Last Name:PRIEBE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:RUNDI
Other - Middle Name:MARIE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2113 255TH ST
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-9854
Mailing Address - Country:US
Mailing Address - Phone:319-334-4311
Mailing Address - Fax:
Practice Address - Street 1:2300 SWAN LAKE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-9707
Practice Address - Country:US
Practice Address - Phone:319-334-4311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03475225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA37046OtherBCBS PROVIDER #