MEDICARE: DR. PETER JOSEPH NEIBERT PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	AT641	KY
2	2255A2300X	Athletic Trainer	AT002458	OH

General Provider Information

NPI Number	:	1144281601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER JOSEPH NEIBERT PHD

Provider Business Mailing Address
First Line	:	10068 ARMSTRONG ST
Second Line	:
City	:	UNION
State	:	KY
Zip	:	41091-7438
Country	:	US
Telephone Number	:	859-384-3066
Fax Number	:

Provider Business Practice Location Address
First Line	:	10068 ARMSTRONG ST
Second Line	:
City	:	UNION
State	:	KY
Zip	:	41091-7438
Country	:	US
Telephone Number	:	859-468-3953
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	07/08/2007

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