Provider Demographics
NPI:1457312167
Name:SACKSTEDER, JOAN CHRISTINE (PT)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:CHRISTINE
Last Name:SACKSTEDER
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 1:49918 POINTE XING
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-6434
Mailing Address - Country:US
Mailing Address - Phone:734-612-0464
Mailing Address - Fax:
Practice Address - Street 1:26771 W 12 MILE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1539
Practice Address - Country:US
Practice Address - Phone:248-945-9905
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008864225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist