Provider Demographics
NPI:1649666587
Name:IRLBECK, HEIDI JO (DPT, ATC)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:JO
Last Name:IRLBECK
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19554 LASER AVE
Mailing Address - Street 2:
Mailing Address - City:SANBORN
Mailing Address - State:MN
Mailing Address - Zip Code:56083-3015
Mailing Address - Country:US
Mailing Address - Phone:507-637-4606
Mailing Address - Fax:
Practice Address - Street 1:100 FALLWOOD RD
Practice Address - Street 2:
Practice Address - City:REDWOOD FALLS
Practice Address - State:MN
Practice Address - Zip Code:56283-1828
Practice Address - Country:US
Practice Address - Phone:507-637-4606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6912225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist