Provider Demographics
NPI:1659565133
Name:SIEHR, KRISTIN MICHELE (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MICHELE
Last Name:SIEHR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:MICHELE
Other - Last Name:FLAIG-NOVAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:N49W6693 WESTERN RD
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-1804
Mailing Address - Country:US
Mailing Address - Phone:414-944-1164
Mailing Address - Fax:
Practice Address - Street 1:N49W6693 WESTERN RD
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-1804
Practice Address - Country:US
Practice Address - Phone:414-944-1164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10888-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1659565133Medicaid
WI1831358662Medicaid
WI10888-24OtherPHYSICAL THERAPIST
WI000086454Medicare PIN
WI000085185Medicare PIN