Healthcare Provider Details

I. General information

NPI: 1255246971
Provider Name (Legal Business Name): KRISTINA SUZANNE SIKORSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 PORT WASHINGTON RD
GRAFTON WI
53024-9204
US

IV. Provider business mailing address

975 PORT WASHINGTON RD
GRAFTON WI
53024-9204
US

V. Phone/Fax

Practice location:
  • Phone: 262-329-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14252-146
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: