Provider Demographics
NPI:1063769099
Name:NIZNICK, AARON JOHN (DPT, ATC)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:JOHN
Last Name:NIZNICK
Suffix:
Gender:M
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1564 ROUTE 507
Mailing Address - Street 2:SUITE C
Mailing Address - City:GREENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18426-4502
Mailing Address - Country:US
Mailing Address - Phone:570-676-0700
Mailing Address - Fax:570-676-0766
Practice Address - Street 1:1564 ROUTE 507
Practice Address - Street 2:SUITE C
Practice Address - City:GREENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18426-4502
Practice Address - Country:US
Practice Address - Phone:570-676-0700
Practice Address - Fax:570-676-0766
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022287225100000X
RT0044862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer