Provider Demographics
NPI:1275861866
Name:SIKKEMA, JOHANNES RENZE (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:JOHANNES
Middle Name:RENZE
Last Name:SIKKEMA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 864
Mailing Address - Street 2:
Mailing Address - City:BIGFORK
Mailing Address - State:MT
Mailing Address - Zip Code:59911-0864
Mailing Address - Country:US
Mailing Address - Phone:406-300-0452
Mailing Address - Fax:406-730-6555
Practice Address - Street 1:120 ROUNDSTONE DR STE 103
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3743
Practice Address - Country:US
Practice Address - Phone:406-300-0452
Practice Address - Fax:406-730-6555
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT36208225100000X, 2251X0800X
WY14082251X0800X
MT13085225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic