Provider Demographics
NPI:1518255314
Name:SIEDER, SCOTT (PT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:SIEDER
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 1:1071 E ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-6609
Mailing Address - Country:US
Mailing Address - Phone:630-682-1785
Mailing Address - Fax:630-682-1854
Practice Address - Street 1:1071 E ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-6609
Practice Address - Country:US
Practice Address - Phone:630-682-1785
Practice Address - Fax:630-682-1854
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-018506225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist