MEDICARE: STUART SIEGNER PT CSCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501004149	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5176007	OTHER		AETNA

General Provider Information

NPI Number	:	1184707135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STUART SIEGNER PT CSCS

Provider Business Mailing Address
First Line	:	878 S ROCHESTER RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-2740
Country	:	US
Telephone Number	:	248-601-9207
Fax Number	:	248-650-8670

Provider Business Practice Location Address
First Line	:	878 S ROCHESTER RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-2740
Country	:	US
Telephone Number	:	248-650-4404
Fax Number	:	248-650-4757

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	03/12/2008

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