Provider Demographics
NPI:1114994407
Name:SIEWERT, DARLA M (DPT)
Entity Type:Individual
Prefix:DR
First Name:DARLA
Middle Name:M
Last Name:SIEWERT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DARLA
Other - Middle Name:MAE
Other - Last Name:SUSENBACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6263 CROCUS CT
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-4301
Mailing Address - Country:US
Mailing Address - Phone:804-569-9302
Mailing Address - Fax:
Practice Address - Street 1:210 ENGLAND ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-2015
Practice Address - Country:US
Practice Address - Phone:804-798-1591
Practice Address - Fax:804-798-1593
Is Sole Proprietor?:No
Enumeration Date:2006-03-05
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204326225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist