Provider Demographics
NPI:1366764102
Name:KLEEB, TERESA YVONNE (LMT)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:YVONNE
Last Name:KLEEB
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:TERESA
Other - Middle Name:YVONNE
Other - Last Name:BROEKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:738 SOUTH C STREET
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:NE
Mailing Address - Zip Code:68822-2031
Mailing Address - Country:US
Mailing Address - Phone:308-872-6853
Mailing Address - Fax:308-872-6853
Practice Address - Street 1:738 S C ST
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:NE
Practice Address - Zip Code:68822-2031
Practice Address - Country:US
Practice Address - Phone:308-872-6853
Practice Address - Fax:308-872-6853
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1747172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist