Basic Information
| Provider Information | |||||||||
| NPI: | 1194116749 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAISER | ||||||||
| FirstName: | MARIE | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | DAHLHOFF | ||||||||
| OtherFirstName: | MARIE | ||||||||
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| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 812 CANBY ST | ||||||||
| Address2: | |||||||||
| City: | VERMILLION | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570693503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052020615 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 401 W DARLENE ST | ||||||||
| Address2: | |||||||||
| City: | HARTINGTON | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687394510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4022543905 | ||||||||
| FaxNumber: | 4022543963 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2015 | ||||||||
| LastUpdateDate: | 02/17/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 837 | NE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.