Provider Demographics
NPI:1982697470
Name:KRASNIAK, LEWIS JOHN (PTA)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:JOHN
Last Name:KRASNIAK
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 SUNRISE AVE
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1085
Mailing Address - Country:US
Mailing Address - Phone:570-251-8003
Mailing Address - Fax:570-251-8005
Practice Address - Street 1:232 SUNRISE AVE
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1085
Practice Address - Country:US
Practice Address - Phone:570-251-8003
Practice Address - Fax:570-251-8005
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE006724225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant