Provider Demographics
NPI:1528333895
Name:NIEHUS, JEFFREY LEE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LEE
Last Name:NIEHUS
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 LAURELANN DR
Mailing Address - Street 2:CITY
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5341
Mailing Address - Country:US
Mailing Address - Phone:937-434-2312
Mailing Address - Fax:
Practice Address - Street 1:609 LAURELANN DR
Practice Address - Street 2:CITY
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-5341
Practice Address - Country:US
Practice Address - Phone:937-434-2312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4243174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4243OtherOHIO STATE BOARD PT/OT