Provider Demographics
NPI:1043043094
Name:SIERZEGA, MATTHEW DAVID (ATC, LAT, MS)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DAVID
Last Name:SIERZEGA
Suffix:
Gender:M
Credentials:ATC, LAT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-3816
Mailing Address - Country:US
Mailing Address - Phone:224-246-1021
Mailing Address - Fax:
Practice Address - Street 1:2220 CHURCH ST
Practice Address - Street 2:
Practice Address - City:JOHNSBURG
Practice Address - State:IL
Practice Address - Zip Code:60051-5910
Practice Address - Country:US
Practice Address - Phone:224-246-1021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-24
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0058362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer