Provider Demographics
NPI:1033413612
Name:NIEUWENHUIS, PIETER (PT)
Entity Type:Individual
Prefix:MR
First Name:PIETER
Middle Name:
Last Name:NIEUWENHUIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:LAKE LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:49945-1220
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1310 FRONT ST
Practice Address - Street 2:
Practice Address - City:LAKE LINDEN
Practice Address - State:MI
Practice Address - Zip Code:49945-1220
Practice Address - Country:US
Practice Address - Phone:906-296-0985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010133402251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics