Healthcare Provider Details

I. General information

NPI: 1649868704
Provider Name (Legal Business Name): CIERRA RACHEL NEIDERMEYER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 NEWTOWN RD
VIRGINIA BEACH VA
23462-1116
US

IV. Provider business mailing address

818 NEWTOWN RD
VIRGINIA BEACH VA
23462-1116
US

V. Phone/Fax

Practice location:
  • Phone: 757-261-4475
  • Fax: 757-222-3156
Mailing address:
  • Phone: 757-261-4475
  • Fax: 757-222-3156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305213642
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: