Provider Demographics
NPI:1033952197
Name:KACZOCHA, SIERRA RENEE
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:RENEE
Last Name:KACZOCHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 392977
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-9977
Mailing Address - Country:US
Mailing Address - Phone:724-343-4060
Mailing Address - Fax:
Practice Address - Street 1:200 QUEBEC ST
Practice Address - Street 2:#215
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7144
Practice Address - Country:US
Practice Address - Phone:303-341-0369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0020243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist