Provider Demographics
NPI:1609376342
Name:SIER, ROBERTUS HENDRIKUS (PT)
Entity Type:Individual
Prefix:
First Name:ROBERTUS
Middle Name:HENDRIKUS
Last Name:SIER
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 1:17101 ROTUNDA DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-4084
Mailing Address - Country:US
Mailing Address - Phone:313-791-4333
Mailing Address - Fax:313-791-4310
Practice Address - Street 1:17101 ROTUNDA DR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4084
Practice Address - Country:US
Practice Address - Phone:313-791-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004609225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist