1659565133 NPI number — KRISTIN MICHELE SIEHR DPT

Table of content: COURTNEY NICOLE FRANKE (NPI 1922727338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659565133 NPI number — KRISTIN MICHELE SIEHR DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIEHR
Provider First Name:
KRISTIN
Provider Middle Name:
MICHELE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FLAIG-NOVAK
Provider Other First Name:
KRISTIN
Provider Other Middle Name:
MICHELE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659565133
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
N49W6693 WESTERN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDARBURG
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53012-1804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-944-1164
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
N49W6693 WESTERN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDARBURG
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53012-1804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-944-1164
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  10888-24 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1659565133 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1831358662 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10888-24 . This is a "PHYSICAL THERAPIST" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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