Provider Demographics
NPI:1164770053
Name:SIEGRIST, KATIE (CPTA)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:SIEGRIST
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 17TH ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY FALLS
Mailing Address - State:KS
Mailing Address - Zip Code:66088-1355
Mailing Address - Country:US
Mailing Address - Phone:785-224-9747
Mailing Address - Fax:
Practice Address - Street 1:1045 SW GAGE BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1780
Practice Address - Country:US
Practice Address - Phone:785-273-7700
Practice Address - Fax:785-273-2751
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1402356225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant