Provider Demographics
NPI:1093190696
Name:PESA, VIOLETA (PT)
Entity Type:Individual
Prefix:
First Name:VIOLETA
Middle Name:
Last Name:PESA
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 1:1600 SYCAMORE RD APT 11
Mailing Address - Street 2:
Mailing Address - City:MONTOURSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17754-9587
Mailing Address - Country:US
Mailing Address - Phone:954-803-7258
Mailing Address - Fax:
Practice Address - Street 1:1445 SYCAMORE RD
Practice Address - Street 2:
Practice Address - City:MONTOURSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17754-9519
Practice Address - Country:US
Practice Address - Phone:570-601-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT023619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist