1386858207 NPI number — CHRISTINA SEEFELDT P.T.

Table of content: CHRISTINA SEEFELDT P.T. (NPI 1386858207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386858207 NPI number — CHRISTINA SEEFELDT P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEEFELDT
Provider First Name:
CHRISTINA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KMIEC
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386858207
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 OAKMONT LN STE 600C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTMONT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60559-5548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-575-1980
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
902 S WELLS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE GENEVA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53147-2422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-249-1915
Provider Business Practice Location Address Fax Number:
262-249-1397
Provider Enumeration Date:
05/09/2007

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:  10265-024 , 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: 859400067 . This is a "MEDICARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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