Provider Demographics
NPI:1114023983
Name:SEIBOLD, JANA M (PT)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:M
Last Name:SEIBOLD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7960 E THOMPSON PEAK PKWY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-7406
Mailing Address - Country:US
Mailing Address - Phone:480-585-6810
Mailing Address - Fax:480-585-6910
Practice Address - Street 1:7960 E THOMPSON PEAK PKWY
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7406
Practice Address - Country:US
Practice Address - Phone:480-585-6810
Practice Address - Fax:480-585-6910
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7379225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7379OtherPT LICENSE
AZZ114974Medicare PIN