Provider Demographics
NPI:1962069666
Name:SIEFKER, ALEXA (PT, DPT)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:SIEFKER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:
Other - Last Name:KATRINCHAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3864 CENTER RD STE B1
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-6601
Mailing Address - Country:US
Mailing Address - Phone:330-220-8950
Mailing Address - Fax:855-389-1612
Practice Address - Street 1:3864 CENTER RD STE B1
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-6601
Practice Address - Country:US
Practice Address - Phone:330-220-8950
Practice Address - Fax:855-389-1612
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT017862225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist