MEDICARE: DANIEL J. FICK M.P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT006501L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	409359	OTHER	PA	HIGHMARK BLUE SHIELD
2	134938	OTHER	PA	HEALTH AMER/HEALTH ASSUR.
3	0306737000	OTHER	PA	INDEPENDENCE BLUE CROSS
4	02990801	OTHER	PA	CAPITAL/KHPC

General Provider Information

NPI Number	:	1679679385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL J. FICK M.P.T.

Provider Business Mailing Address
First Line	:	430 INNOVATION DRIVE
Second Line	:
City	:	BLAIRSVILLE
State	:	PA
Zip	:	15717-8096
Country	:	US
Telephone Number	:	724-343-4060
Fax Number	:	724-343-4069

Provider Business Practice Location Address
First Line	:	21 S PINE ST
Second Line	:	HERITAGE MEDICAL CENTER
City	:	ELVERSON
State	:	PA
Zip	:	19520-9720
Country	:	US
Telephone Number	:	610-286-0977
Fax Number	:	610-286-0986

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	01/14/2015

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