Provider Demographics
NPI:1841219920
Name:STIEGEMEIER, DEREK LOUIS (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:LOUIS
Last Name:STIEGEMEIER
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
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Other - First Name:
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Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:STE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:415 E PARKCENTER BLVD
Practice Address - Street 2:SUITE 114
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-6504
Practice Address - Country:US
Practice Address - Phone:208-433-9211
Practice Address - Fax:208-433-9241
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2013-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDPT2080225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1841219920-000Medicaid
ID807688400Medicaid
ID1841219920Medicaid
ID1841219920-002Medicaid
IDP00704722OtherRR MEDICARE
ID1841219920-001Medicaid
ID807688400Medicaid