Individual provider Active NPI

Jeff Nievierowski, PT

  • Physical Therapist
  • Flint, MI
National Provider Identifier
1578613956
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501012403 Issued in MI
Practice address
2841 Brandon St
Flint, MI 48503-3468
Phone
(989) 992-1367
NPI assigned
Jan 10, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5501012403 MI Primary

Addresses

Primary practice location

2841 Brandon St
Flint, MI 48503-3468

Mailing address

2841 Brandon St
Flint, MI 48503-3468
Phone (989) 992-1367

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080218000093 MI Practitioner - Physical Therapist in Private Practice 4284717059 Reassigns benefits to 2 organizations
Practice locations: Bay City, MI

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5501012403MIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Peak Rehab LLC Physical Therapist CurrentSince Mar 1, 2024 Accepting new patients
Legacy Healthcare Services Inc Physical Therapist CurrentSince Oct 29, 2020 Accepting new patients
Legacy Healthcare Services Inc Physical Therapist CurrentSince Oct 29, 2020 Accepting new patients

Locations

110 Horizon Dr
Ste 310
Raleigh, NC 27615
Phone (970) 215-3300

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1578613956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2841 BRANDON ST",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485033468",
            "telephone_number": "989-992-1367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2841 BRANDON ST",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485033468",
            "telephone_number": "989-992-1367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIEVIEROWSKI",
        "first_name": "JEFF",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501012403",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flint, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.