Provider Demographics
NPI:1245280254
Name:HIEB, NADA DANIELLE (PT)
Entity type:Individual
Prefix:MRS
First Name:NADA
Middle Name:DANIELLE
Last Name:HIEB
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NADA
Other - Middle Name:DANIELLE
Other - Last Name:PHINNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:4405 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403
Mailing Address - Country:US
Mailing Address - Phone:715-847-2000
Mailing Address - Fax:715-847-2046
Practice Address - Street 1:3200 WESTHILL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4705
Practice Address - Country:US
Practice Address - Phone:715-847-2827
Practice Address - Fax:715-847-2046
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9775024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36153700Medicaid
WI78778OtherSECURITY HEALTH
WI526555Medicare ID - Type Unspecified