Provider Demographics
NPI:1447812300
Name:EIPP, NIOMI SUE (PT,DPT)
Entity type:Individual
Prefix:MRS
First Name:NIOMI
Middle Name:SUE
Last Name:EIPP
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 PINE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1137
Mailing Address - Country:US
Mailing Address - Phone:315-326-0056
Mailing Address - Fax:315-326-0102
Practice Address - Street 1:364 EAST AVE
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-6148
Practice Address - Country:US
Practice Address - Phone:315-326-0056
Practice Address - Fax:315-326-0102
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044321-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist