Provider Demographics
NPI:1750365326
Name:JOHNSONSIEKMANN, ELAINE D (PT, DPT)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:D
Last Name:JOHNSONSIEKMANN
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 1:13400 E SHEA BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-5452
Mailing Address - Country:US
Mailing Address - Phone:480-301-8000
Mailing Address - Fax:
Practice Address - Street 1:20199 N 75TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8807
Practice Address - Country:US
Practice Address - Phone:623-561-5252
Practice Address - Fax:623-561-8868
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ747355Medicaid
AZ650026156OtherRAILROAD MEDICARE
AZ747355Medicaid
AZZ72878Medicare PIN