Provider Demographics
NPI:1245765072
Name:KAHLER, SIERRA JEANNE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:JEANNE
Last Name:KAHLER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SIERRA
Other - Middle Name:JEANNE
Other - Last Name:MAUCORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1825 19TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4714
Mailing Address - Country:US
Mailing Address - Phone:701-412-1230
Mailing Address - Fax:
Practice Address - Street 1:2400 32ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103
Practice Address - Country:US
Practice Address - Phone:701-234-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-30
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10280225100000X
ND2111225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist