Individual
MR. DEREK LOUIS STIEGEMEIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICAL THERAPIST
Contact information
Practice address
415 E PARKCENTER BLVD, SUITE 114, BOISE, ID 83706-6504
(208) 433-9211
(208) 433-9241
Mailing address
16083 SW UPPER BOONES FERRY RD, STE 300, TIGARD, OR 97224-7736
(800) 219-8835
(503) 639-9699
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT2080
ID
225100000X
Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841219920
—
ID
05
—
1841219920-000
—
ID
05
—
1841219920-001
—
ID
05
—
1841219920-002
—
ID
05
—
807688400
—
ID
01
—
P00704722
RR MEDICARE
ID
Enumeration date
07/19/2006
Last updated
12/03/2013
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