Provider Demographics
NPI:1023552684
Name:SIPIORSKI, STACEY
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:SIPIORSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:HOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2999 N MAYFAIR RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-4306
Mailing Address - Country:US
Mailing Address - Phone:414-479-3737
Mailing Address - Fax:414-479-3733
Practice Address - Street 1:2999 N MAYFAIR RD
Practice Address - Street 2:SUITE 300
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-4306
Practice Address - Country:US
Practice Address - Phone:414-479-3737
Practice Address - Fax:414-479-3733
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11600-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist