Individual
PHILLIP NIERSTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
25778 LAKE AMELIA WAY, BONITA SPRINGS, FL 34135-3814
(239) 220-9392
Mailing address
25778 LAKE AMELIA WAY, BONITA SPRINGS, FL 34135-3814
(239) 220-9392
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA 19346
FL
Other
Enumeration date
10/09/2016
Last updated
10/09/2016
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