Individual provider Active NPI

David J Wieber, A.T.C.,M.T.C.,L.P.T

  • Physical Therapist
  • Faribault, MN
National Provider Identifier
1679548424
Registry record updated Sep 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
4148 Issued in MN
Practice address
328 Heritage PL
Suite B
Faribault, MN 55021-5251
Phone
(507) 333-2986
Fax
(507) 333-2918
NPI assigned
Feb 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 4148 MN Primary

Addresses

Primary practice location

328 Heritage PL
Suite B
Faribault, MN 55021-5251

Mailing address

1961 Cardinal LN
Ste a
Faribault, MN 55021-4354
Phone (507) 645-2235

Other identifiers 1

IdentifierTypeStateIssuer
644723600MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040819000883 MN Practitioner - Physical Therapist in Private Practice 0840193660 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1961 Cardinal LN a
Faribault, MN 55021-4354

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4148MNMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Therapy Partners, Inc. Physical Therapist CurrentSince Apr 15, 2015 Accepting new patients
Therapy Partners Inc Physical Therapist CurrentSince Apr 15, 2015 Accepting new patients
Body Balance Golf & Physical Therapy, LLC Physical Therapist PastSince Mar 22, 2006 Accepting new patients

Locations

1961 Cardinal Ln
Ste A
Faribault, MN 55021
Phone (507) 333-2986

1939 Minnehaha Ave W
Ste 300
Saint Paul, MN 55104

1700 Tower Dr W
Stillwater, MN 55082
Phone (651) 275-4706

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505779200000",
    "number": "1679548424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1961 CARDINAL LN",
            "address_2": "STE A",
            "city": "FARIBAULT",
            "state": "MN",
            "postal_code": "550214354",
            "telephone_number": "507-645-2235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "328 HERITAGE PL",
            "address_2": "SUITE B",
            "city": "FARIBAULT",
            "state": "MN",
            "postal_code": "550215251",
            "telephone_number": "507-333-2986",
            "fax_number": "507-333-2918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEBER",
        "first_name": "DAVID",
        "middle_name": "J",
        "credential": "A.T.C.,M.T.C.,L.P.T",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-22",
        "last_updated": "2017-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "4148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "644723600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Faribault, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.