Active NPI
Gene R Niec, PTA
- Physical Therapy Assistant
- Iron Mountain, MI
National Provider Identifier
1063688893
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 1152-019
- Practice address
- W8515 Merriman West Rd # B
Iron Mountain, MI 49801-9553 - Phone
- (906) 779-1394
- NPI assigned
- May 1, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 1152-019 | WI | Primary |
Addresses
Primary practice location
W8515 Merriman West Rd # B
Iron Mountain, MI 49801-9553
Mailing address
W8515 Merriman West Rd # B
Iron Mountain, MI 49801-9553
Phone (906) 779-1394
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40440800 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1152-019 | WI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209600000000",
"number": "1063688893",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "W8515 MERRIMAN WEST RD # B",
"city": "IRON MOUNTAIN",
"state": "MI",
"postal_code": "498019553",
"telephone_number": "906-779-1394"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "W8515 MERRIMAN WEST RD # B",
"city": "IRON MOUNTAIN",
"state": "MI",
"postal_code": "498019553",
"telephone_number": "906-779-1394"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIEC",
"first_name": "GENE",
"middle_name": "R",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-01",
"last_updated": "2008-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "1152-019",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40440800",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Iron Mountain, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.