Provider Demographics
NPI:1063424349
Name:SEKERAK, ERNEST J (MPT, CSCS)
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:J
Last Name:SEKERAK
Suffix:
Gender:M
Credentials:MPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 SHOEMAKER ST
Mailing Address - Street 2:
Mailing Address - City:NANTY GLO
Mailing Address - State:PA
Mailing Address - Zip Code:15943-1248
Mailing Address - Country:US
Mailing Address - Phone:814-749-3355
Mailing Address - Fax:814-749-3362
Practice Address - Street 1:1300 PHILADELPHIA AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:NORTHERN CAMBRIA
Practice Address - State:PA
Practice Address - Zip Code:15714-1166
Practice Address - Country:US
Practice Address - Phone:814-948-8220
Practice Address - Fax:814-948-8223
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103726057Medicaid
PA101379176Medicaid