Provider Demographics
NPI:1184707135
Name:SIEGNER, STUART (PT CSCS)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:SIEGNER
Suffix:
Gender:M
Credentials:PT CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 S ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2740
Mailing Address - Country:US
Mailing Address - Phone:248-601-9207
Mailing Address - Fax:248-650-8670
Practice Address - Street 1:878 S ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2740
Practice Address - Country:US
Practice Address - Phone:248-650-4404
Practice Address - Fax:248-650-4757
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5176007OtherAETNA
OM78170Medicare ID - Type Unspecified