Provider Demographics
NPI:1417908294
Name:NIEBERGALL, JAMES RICHARD (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:RICHARD
Last Name:NIEBERGALL
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:PO BOX 1979
Mailing Address - Street 2:
Mailing Address - City:ESTACADA
Mailing Address - State:OR
Mailing Address - Zip Code:97023-1979
Mailing Address - Country:US
Mailing Address - Phone:503-630-5314
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1979
Practice Address - Street 2:SUITE 101 TAI BETHANY PHYSICAL THERAPY
Practice Address - City:ESTACADA
Practice Address - State:OR
Practice Address - Zip Code:97023-1979
Practice Address - Country:US
Practice Address - Phone:503-466-2254
Practice Address - Fax:503-466-1143
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5165225100000X
WAPT00007392225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist