Provider Demographics
NPI:1619931102
Name:BIEBER, JEREMY (PT, DPT, OCS)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:
Last Name:BIEBER
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 S POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-6104
Mailing Address - Country:US
Mailing Address - Phone:307-333-2873
Mailing Address - Fax:307-333-4034
Practice Address - Street 1:4120 S POPLAR ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-6104
Practice Address - Country:US
Practice Address - Phone:307-333-2873
Practice Address - Fax:307-333-4034
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-1140225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY20518Medicare ID - Type Unspecified