Individual
SAMUEL LEE NIEDERGERKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
741S RAY RD, FORT RILEY, KS 66442
(573) 230-7959
Mailing address
909 WAXWING DR, MANHATTAN, KS 66502-6747
(573) 230-7959
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
096005167
IL
2255A2300X
Athletic Trainer
Primary
24-01823
KS
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/02/2017
Last updated
12/30/2025
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