Mark A. Niebuhr, PT

Key facts

NPI

1679615934

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapist 225100000X

License

3134-024 (WI)

Practice address

310 W Main Street
Sparta, WI 54665-2170

Phone

(608) 269-2132

NPI assigned

Feb 13, 2007

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 28, 2011.

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325030400000",
    "number": "1679615934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 W. MAIN STREET",
            "city": "SPARTA",
            "state": "WI",
            "postal_code": "546652170",
            "telephone_number": "608-269-2132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 W MAIN STREET",
            "city": "SPARTA",
            "state": "WI",
            "postal_code": "546652170",
            "telephone_number": "608-269-2132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIEBUHR",
        "first_name": "MARK",
        "middle_name": "A.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2011-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "3134-024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Sparta, WI · Physical Therapist in Wisconsin