Provider Demographics
NPI:1922463157
Name:NIEMI, LAUREN M (DPT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:NIEMI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 W BELTLINE HWY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2334
Mailing Address - Country:US
Mailing Address - Phone:608-260-6004
Mailing Address - Fax:608-250-1456
Practice Address - Street 1:1806 W BELTLINE HWY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-2334
Practice Address - Country:US
Practice Address - Phone:608-260-6004
Practice Address - Fax:608-250-1456
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13217-24225100000X
IL070023045225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1922463157Medicaid