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Individual
CORY E NIEDFELDT
Active
Individual
CORY E NIEDFELDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
01779
LA
225100000X
Physical Therapist
070013292
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619980
BCBS OF IL
IL
01
—
567700
MEDICARE GROUP NUMBER
IL
01
—
568080
MEDICARE GROUP NUMBER
IL
01
—
568150
MEDICARE GROUP NUMBER
IN
Enumeration date
09/06/2007
Last updated
03/22/2023
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