Provider Demographics
NPI:1508152042
Name:NIEMAN, KIMBERLY (DPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:NIEMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 W HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:GARNAVILLO
Mailing Address - State:IA
Mailing Address - Zip Code:52049-9765
Mailing Address - Country:US
Mailing Address - Phone:563-608-4570
Mailing Address - Fax:563-252-5528
Practice Address - Street 1:200 MAIN STREET
Practice Address - Street 2:BOX 550
Practice Address - City:GUTTENBERG
Practice Address - State:IA
Practice Address - Zip Code:52052
Practice Address - Country:US
Practice Address - Phone:563-252-5527
Practice Address - Fax:563-252-5528
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004696225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist