Provider Demographics
NPI:1518435049
Name:NIEDEREE, ALLISON MICHELLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:MICHELLE
Last Name:NIEDEREE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 NE 20 AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-9259
Mailing Address - Country:US
Mailing Address - Phone:620-617-4852
Mailing Address - Fax:
Practice Address - Street 1:156 NE 20 AVE
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-9259
Practice Address - Country:US
Practice Address - Phone:620-617-4852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295724225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist