Provider Demographics
NPI:1821255910
Name:SEIBERLICH, CHRISTINE WICHMAN (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:WICHMAN
Last Name:SEIBERLICH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 LIBAL ST
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-3649
Mailing Address - Country:US
Mailing Address - Phone:920-337-6535
Mailing Address - Fax:
Practice Address - Street 1:126 LIBAL ST
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-3649
Practice Address - Country:US
Practice Address - Phone:920-337-6535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-18
Last Update Date:2008-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1971-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist