Healthcare Provider Details

I. General information

NPI: 1104656040
Provider Name (Legal Business Name): JAMES PLISKA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W WASHINGTON SQ FL 5
PHILADELPHIA PA
19106-3500
US

IV. Provider business mailing address

412 JONES ST
DURYEA PA
18642-1417
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-7025
  • Fax:
Mailing address:
  • Phone: 570-855-2981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT032612
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: