Provider Demographics
NPI:1871943860
Name:SIEFKEN, KATRINA MARIE
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:MARIE
Last Name:SIEFKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:MARIE
Other - Last Name:MICA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12413 JUDSON RD
Mailing Address - Street 2:STE 260
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3202
Mailing Address - Country:US
Mailing Address - Phone:210-656-7953
Mailing Address - Fax:210-656-7957
Practice Address - Street 1:12413 JUDSON RD
Practice Address - Street 2:STE 260
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3202
Practice Address - Country:US
Practice Address - Phone:210-656-7953
Practice Address - Fax:210-656-7957
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1275225225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist