Individual
KELLY NIEMEYER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4810 BARBICAN AVE, WESTON, WI 54476-4186
(715) 393-0419
Mailing address
5157 N 28TH AVE APT 16, WAUSAU, WI 54401-8380
(715) 308-8126
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3207-19
WI
Other
Enumeration date
09/03/2021
Last updated
03/05/2024
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