Basic Information
| Provider Information | |||||||||
| NPI: | 1417908294 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NIEBERGALL | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | RICHARD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1979 | ||||||||
| Address2: | |||||||||
| City: | ESTACADA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970231979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036305314 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | PO BOX 1979 | ||||||||
| Address2: | SUITE 101 TAI BETHANY PHYSICAL THERAPY | ||||||||
| City: | ESTACADA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970231979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034662254 | ||||||||
| FaxNumber: | 5034661143 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 02/28/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5165 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT00007392 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.