Provider Demographics
NPI:1053490060
Name:SIEGFRIED, DAVID ROBERT (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ROBERT
Last Name:SIEGFRIED
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 530
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CO
Mailing Address - Zip Code:80446
Mailing Address - Country:US
Mailing Address - Phone:970-887-2733
Mailing Address - Fax:
Practice Address - Street 1:17 TEN MILE DR, UNIT D
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CO
Practice Address - Zip Code:80446
Practice Address - Country:US
Practice Address - Phone:970-887-2733
Practice Address - Fax:970-887-0133
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5490225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C537148Medicare ID - Type Unspecified