Provider Demographics
NPI:1902197775
Name:SIEFKER, MARY PATRICIA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:PATRICIA
Last Name:SIEFKER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 CENTRAL PARK W
Mailing Address - Street 2:STE. A
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1094
Mailing Address - Country:US
Mailing Address - Phone:419-841-9622
Mailing Address - Fax:419-843-8288
Practice Address - Street 1:3130 CENTRAL PARK W
Practice Address - Street 2:STE. A
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1094
Practice Address - Country:US
Practice Address - Phone:419-841-9622
Practice Address - Fax:419-843-8288
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02124225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant