Provider Demographics
NPI:1114188141
Name:SIEBERT, CHRISTY J (DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:J
Last Name:SIEBERT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:J
Other - Last Name:MOORMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:14362 S BLACKFEATHER DR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-4647
Mailing Address - Country:US
Mailing Address - Phone:785-554-2428
Mailing Address - Fax:
Practice Address - Street 1:7105 MISSION RD
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208
Practice Address - Country:US
Practice Address - Phone:913-962-1611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008015435225100000X
KS11-03889225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
41402046OtherBCBS KC
KSKA2868040OtherMEDICARE PTAN
MOMA4370020OtherMEDICARE PTAN