Individual
COURTNEY JEAN NIESENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
3624 W 10TH ST, GREELEY, CO 80634-1821
(970) 353-2101
(970) 353-0754
Mailing address
3624 W 10TH ST, GREELEY, CO 80634-1821
(970) 353-2101
(970) 353-0754
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
9647
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9647
STATE LICENSE NUMBER
CO
Enumeration date
07/06/2007
Last updated
10/15/2007
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