Provider Demographics
NPI:1871651661
Name:NIERMAN, TODD B (PT, CSCS)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:B
Last Name:NIERMAN
Suffix:
Gender:M
Credentials:PT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5973 EXECUTIVE DR
Mailing Address - Street 2:SUITE #3
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53719-5303
Mailing Address - Country:US
Mailing Address - Phone:608-663-1090
Mailing Address - Fax:608-663-1097
Practice Address - Street 1:5973 EXECUTIVE DR
Practice Address - Street 2:SUITE #3
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53719-5303
Practice Address - Country:US
Practice Address - Phone:608-663-1090
Practice Address - Fax:608-663-1097
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4757-0242251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36113000Medicaid