Provider Demographics
NPI:1801836630
Name:NIECKARZ, NEIL P (PT)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:P
Last Name:NIECKARZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3312 GLANZMAN RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-3856
Mailing Address - Country:US
Mailing Address - Phone:419-382-8141
Mailing Address - Fax:419-382-7081
Practice Address - Street 1:3318 GLANZMAN RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-3856
Practice Address - Country:US
Practice Address - Phone:419-382-9578
Practice Address - Fax:419-382-9824
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT007616225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000168967OtherANTHEM