Provider Demographics
NPI:1588239677
Name:NIEMET, MADELEINE SUZANNE (DPT)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:SUZANNE
Last Name:NIEMET
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MADELEINE
Other - Middle Name:SUZANNE
Other - Last Name:ROPPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2635 NW ROLLING GREEN DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3519
Mailing Address - Country:US
Mailing Address - Phone:541-752-0545
Mailing Address - Fax:541-757-0545
Practice Address - Street 1:613 HICKORY ST NW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1752
Practice Address - Country:US
Practice Address - Phone:541-928-1411
Practice Address - Fax:541-757-0545
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR64069225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist