Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | 2035 | MN |
NPI | 1033291646 |
---|---|
Provider Name | Teresa Lynn Fietek |
First Address | Burnsville, MN 55337-5714 |
Second Address | Burnsville, MN 55337-5714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 27/05/2008 |