Healthcare Provider Details

I. General information

NPI: 1538637186
Provider Name (Legal Business Name): CHRISTOPHER JOHN CICIORA PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2018
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13250 WASHINGTON AVE
MOUNT PLEASANT WI
53177-1516
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 262-799-8330
  • Fax:
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15331
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: