Provider Demographics
NPI:1477841427
Name:SIERACKI, JANIECE LYNN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JANIECE
Middle Name:LYNN
Last Name:SIERACKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-7233
Mailing Address - Country:US
Mailing Address - Phone:507-313-0441
Mailing Address - Fax:
Practice Address - Street 1:5034 NEWFOREST DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5459
Practice Address - Country:US
Practice Address - Phone:254-399-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA1251225200000X
WI1564-19225200000X
TX2120490225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant