Provider Demographics
NPI:1861650970
Name:SIECK, STEPHANIE M (DPT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:SIECK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 LINDA DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-2727
Mailing Address - Country:US
Mailing Address - Phone:402-981-1555
Mailing Address - Fax:
Practice Address - Street 1:806 LINDA DR
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-2727
Practice Address - Country:US
Practice Address - Phone:402-981-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-26
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03805225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist