Provider Demographics
NPI:1043424922
Name:CISKOWSKI, DORCAS SUE (PT)
Entity Type:Individual
Prefix:
First Name:DORCAS
Middle Name:SUE
Last Name:CISKOWSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4503 E WHITE ASTER ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6835
Mailing Address - Country:US
Mailing Address - Phone:480-598-9891
Mailing Address - Fax:480-598-9891
Practice Address - Street 1:4503 E WHITE ASTER ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6835
Practice Address - Country:US
Practice Address - Phone:480-598-9891
Practice Address - Fax:480-598-9891
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ06472251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics