Basic Information
| Provider Information | |||||||||
| NPI: | 1073807533 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THIEMENS | ||||||||
| FirstName: | BRITTANY | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 540 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT ANGEL | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973629540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035408701 | ||||||||
| FaxNumber: | 5038459229 | ||||||||
| Practice Location | |||||||||
| Address1: | 540 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT ANGEL | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973629540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038452736 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2011 | ||||||||
| LastUpdateDate: | 06/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 6532 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.