Provider Demographics
NPI:1730293945
Name:NIEMIEC, MATTHEW ALAN (MPT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ALAN
Last Name:NIEMIEC
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:321 PETTIBONE ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-1220
Mailing Address - Country:US
Mailing Address - Phone:248-437-2322
Mailing Address - Fax:248-437-2433
Practice Address - Street 1:321 PETTIBONE ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-1220
Practice Address - Country:US
Practice Address - Phone:248-437-2322
Practice Address - Fax:248-437-2433
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501012952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist