Stephanie Kim Nierenberg, PT

Primary specialty

Geriatric Physical TherapistTaxonomy code 2251G0304X

License

PT28524 Issued in FL

Practice address

4034 Schirra Dr
Jacksonville, FL 32277-1727

Phone

(904) 859-8103

NPI assigned

Oct 1, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tailored Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Jacksonville, FL
  • NPI 1134897374
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1380585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630454400000",
    "number": "1134556590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4034 SCHIRRA DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322771727",
            "telephone_number": "904-859-8103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4034 SCHIRRA DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322771727",
            "telephone_number": "904-859-8103"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "379 Pinehaven Street Ext",
            "address_purpose": "LOCATION",
            "city": "Laurens",
            "state": "SC",
            "postal_code": "293602672",
            "country_code": "US",
            "telephone_number": "864-984-6584 x133",
            "fax_number": "864-984-6464",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NIERENBERG",
        "first_name": "STEPHANIE",
        "middle_name": "KIM",
        "name_prefix": "Dr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-01",
        "last_updated": "2021-09-01",
        "certification_date": "2021-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "SC",
            "license": "7173",
            "primary": false
        },
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "FL",
            "license": "PT28524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "stephanie@tailoredphysicaltherapy.com",
            "affiliation": "N",
            "endpointDescription": "business email HIPPA compliant",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": ".doc, .csv, .htm, . jpeg, .pdf, .xlsx",
            "address_1": "4034 Schirra Dr",
            "city": "Jacksonville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "322771727",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jordyn Paige Niederhiser, M.S., BCBA
• Heather D Nielsen, DO
• Tashera Muray Nielsen
• David J. Niemeyer, M.D.
• Mary Suzanne Niemeyer
• Donald Edward Nies, MD
• Matthew Niesen, ATC
• Oveed Giovanni Nieto Camacho, APRN
• Juan Carlos Nieto Quintero, COTA
• Madeline Nieto-Lacey

• All providers in Jacksonville, FL
• Geriatric Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.