Healthcare Provider Details

I. General information

NPI: 1033529359
Provider Name (Legal Business Name): NANCY PTACEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 05/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 E TRESSLER BLVD
LEWISBURG PA
17837-9272
US

IV. Provider business mailing address

189 E TRESSLER BLVD
LEWISBURG PA
17837-9272
US

V. Phone/Fax

Practice location:
  • Phone: 570-523-4226
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberPT002881E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT002881E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: