MEDICARE: WILLIAM ROY CISEK PT

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	2305202753	VA

General Provider Information

NPI Number	:	1689612160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM ROY CISEK PT

Provider Business Mailing Address
First Line	:	PO BOX 1059
Second Line	:	20435 WASHINGTON ST
City	:	ONLEY
State	:	VA
Zip	:	23418-1059
Country	:	US
Telephone Number	:	757-789-3075
Fax Number	:	757-789-3306

Provider Business Practice Location Address
First Line	:	20435 WASHINGTON ST
Second Line	:
City	:	ONLEY
State	:	VA
Zip	:	23418-1059
Country	:	US
Telephone Number	:	757-789-3075
Fax Number	:	757-789-3306

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

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	08/11/2010

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