Provider Demographics
NPI:1508979972
Name:CEIZYK, MICHEAL E (PT)
Entity Type:Individual
Prefix:
First Name:MICHEAL
Middle Name:E
Last Name:CEIZYK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:WI
Mailing Address - Zip Code:53925-1618
Mailing Address - Country:US
Mailing Address - Phone:920-623-2200
Mailing Address - Fax:
Practice Address - Street 1:134 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3116
Practice Address - Country:US
Practice Address - Phone:920-356-1000
Practice Address - Fax:920-356-0719
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI62032251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40349200Medicaid
WI1034219OtherPHYSICIANS PLUS
WIP00064733OtherRAILROAD MEDICARE
WI61271OtherDEAN HEALTH SYSTEMS
WIP00064733OtherRAILROAD MEDICARE
WI1034219OtherPHYSICIANS PLUS