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General NPI Number Information
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NPI Number | 1083681407
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Entity Type | Individual
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Provider Name | PAUL E NIEMUTH PT,DSC,OCS,SCS,ATC
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Gender | Male
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Dates
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Enumeration Date | 03/03/2006
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Last Update Date | 08/01/2017
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Provider Practice Location Address
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Address Line | 112 ASH ST SUITE 5
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City | SPOONER
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State | WI
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Zip | 54801-1487
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Country | US
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Telephone | 715-635-2518
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Fax | 866-245-8064
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Provider Business Mailing Address
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Address Line | 600 52ND ST STE 240
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City | KENOSHA
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State | WI
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Zip | 53140-3423
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Country | US
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Telephone | 262-925-5000
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Fax | 262-925-5001
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1739
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1811-024
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License Number State | WI
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