Provider Demographics
NPI:1144217704
Name:SIEGRIST, CHRISTINE MARIE (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:SIEGRIST
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 1:415 DAISY CT
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:PA
Mailing Address - Zip Code:18643-1161
Mailing Address - Country:US
Mailing Address - Phone:570-883-7106
Mailing Address - Fax:
Practice Address - Street 1:219 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:TAMAQUA
Practice Address - State:PA
Practice Address - Zip Code:18252-4431
Practice Address - Country:US
Practice Address - Phone:570-668-1889
Practice Address - Fax:570-668-6115
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017084225100000X
2251G0304X, 2251X0800X, 2251P0200X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
1676334OtherHIGHMARK BLUE SHIELD
2350844000OtherINDEPENDENCE BLUE CROSS
2001143OtherKEYSTONE
50044276OtherCAPITAL BLUE CROSS
P00198354OtherRAILROAD MEDICARE
257271OtherHEALTH ASSURANCE
3561767OtherAETNA HMO
818896OtherFIRST PRIORITY HEALTH
11312146OtherCAQH
7610567OtherAETNA PPO
P00198354OtherRAILROAD MEDICARE
7610567OtherAETNA PPO