Provider Demographics
NPI:1114696390
Name:SEIBEL, MARISSA MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:MARIE
Last Name:SEIBEL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:VAHLENKAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2740 8 1/2 ST APT 2
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1950
Mailing Address - Country:US
Mailing Address - Phone:715-933-2539
Mailing Address - Fax:
Practice Address - Street 1:1731 17TH AVE
Practice Address - Street 2:
Practice Address - City:BLOOMER
Practice Address - State:WI
Practice Address - Zip Code:54724-1512
Practice Address - Country:US
Practice Address - Phone:715-568-4669
Practice Address - Fax:715-568-4673
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15564-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist