Provider Demographics
NPI:1366071383
Name:TIETJEN-STROTBECK, MARY (MPT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:TIETJEN-STROTBECK
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 LITTLE MOON TRL
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-3085
Mailing Address - Country:US
Mailing Address - Phone:970-819-2880
Mailing Address - Fax:
Practice Address - Street 1:360 LITTLE MOON TRL
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-3085
Practice Address - Country:US
Practice Address - Phone:970-819-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0006818225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist