Provider Demographics
NPI:1154930816
Name:SICKELKA, KATHERINE (PT, DPT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:SICKELKA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4725 COVENTRY LN NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-7034
Mailing Address - Country:US
Mailing Address - Phone:319-213-4046
Mailing Address - Fax:
Practice Address - Street 1:12162 N RANCHO VISTOSO BLVD STE 120
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-1898
Practice Address - Country:US
Practice Address - Phone:520-229-0009
Practice Address - Fax:520-229-0007
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA099096225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist