Healthcare Provider Details

I. General information

NPI: 1982522397
Provider Name (Legal Business Name): CIARA SIEBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15425 MANCHESTER RD STE 28
BALLWIN MO
63011-3077
US

IV. Provider business mailing address

5576 N WHITE ST
OZARK MO
65721-8063
US

V. Phone/Fax

Practice location:
  • Phone: 636-220-6969
  • Fax:
Mailing address:
  • Phone: 636-220-6969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2021029780
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: