Provider Demographics
NPI:1407323793
Name:SIEBERT, AMALIA JEAN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:AMALIA
Middle Name:JEAN
Last Name:SIEBERT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:AMALIA
Other - Middle Name:JEAN
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:2458 W HUISACHE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-5109
Mailing Address - Country:US
Mailing Address - Phone:904-762-6102
Mailing Address - Fax:
Practice Address - Street 1:2458 W HUISACHE AVE APT 2
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-5109
Practice Address - Country:US
Practice Address - Phone:904-762-6102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2142468208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2142468OtherTEXAS BOARD OF PT
FLPTA25529OtherFL DOH