Healthcare Provider Details

I. General information

NPI: 1245215813
Provider Name (Legal Business Name): PHILLIP PLISKY DPT, ATC, CSCS, OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 12/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 W COLUMBIA ST
EVANSVILLE IN
47710-1617
US

IV. Provider business mailing address

7300 E INDIANA ST
EVANSVILLE IN
47715-2794
US

V. Phone/Fax

Practice location:
  • Phone: 812-759-3001
  • Fax: 812-401-9013
Mailing address:
  • Phone: 812-476-0409
  • Fax: 812-476-1016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05006207A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: