Provider Demographics
NPI:1427059690
Name:SIKORSKAS, MICHAEL D (PT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:SIKORSKAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-8844
Mailing Address - Country:US
Mailing Address - Phone:570-748-2678
Mailing Address - Fax:570-748-4015
Practice Address - Street 1:685 ISLAND RD
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-8844
Practice Address - Country:US
Practice Address - Phone:570-748-2678
Practice Address - Fax:570-748-4015
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007553L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001874773Medicaid
PA966897OtherBC/BS
PA151392OtherHEALTH AMERICA-IND.
PA813956OtherFIRST PRIORITY
PA049936PZUMedicare ID - Type UnspecifiedINDIVIDUAL