Basic Information
| Provider Information | |||||||||
| NPI: | 1477528222 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHULTE-WIEBER | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | |||||||||
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| Credential: | A.T.C., L.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1961 CARDINAL LN | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FARIBAULT | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550214353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5073332986 | ||||||||
| FaxNumber: | 5073332918 | ||||||||
| Practice Location | |||||||||
| Address1: | 1961 CARDINAL LN | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FARIBAULT | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550214353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5073332986 | ||||||||
| FaxNumber: | 5073332918 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2006 | ||||||||
| LastUpdateDate: | 09/19/2017 | ||||||||
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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 | 5231 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 305224900 | 05 | MN | MEDICAID |