Provider Demographics
NPI:1891488763
Name:NIEDERMEIER, MORGIN KODIE (PT)
Entity Type:Individual
Prefix:
First Name:MORGIN
Middle Name:KODIE
Last Name:NIEDERMEIER
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 1:380 ELM ST STE 7
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-3059
Mailing Address - Country:US
Mailing Address - Phone:207-571-3420
Mailing Address - Fax:207-571-3430
Practice Address - Street 1:380 ELM ST STE 7
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-3059
Practice Address - Country:US
Practice Address - Phone:207-571-3420
Practice Address - Fax:207-571-3430
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT6531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist