Provider Demographics
NPI:1174062913
Name:PATZKE, SIERRA (DPT, PT)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:PATZKE
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 N JACKSON ST APT 810
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-7140
Mailing Address - Country:US
Mailing Address - Phone:715-321-3603
Mailing Address - Fax:
Practice Address - Street 1:1029 N JACKSON ST APT 810
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-7140
Practice Address - Country:US
Practice Address - Phone:715-321-3603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist