Provider Demographics
NPI:1962428391
Name:MISHOCK PHYSICAL THERAPY & ASSOCIATES, LLC
Entity type:Organization
Organization Name:MISHOCK PHYSICAL THERAPY & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MISHOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-327-2600
Mailing Address - Street 1:1806 SWAMP PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19525-9307
Mailing Address - Country:US
Mailing Address - Phone:610-327-2600
Mailing Address - Fax:610-327-9050
Practice Address - Street 1:1806 SWAMP PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:GILBERTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19525-9307
Practice Address - Country:US
Practice Address - Phone:610-327-2600
Practice Address - Fax:610-327-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2010-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012572L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1700467OtherHIGHMARK
PA2372393000OtherINDEPENDENCE
1700467OtherHIGHMARK