Provider Demographics
NPI:1114173887
Name:SIEJAK, RONALD J (PT)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:J
Last Name:SIEJAK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BLACK STREET
Mailing Address - Street 2:
Mailing Address - City:ASHLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18643
Mailing Address - Country:US
Mailing Address - Phone:570-823-7396
Mailing Address - Fax:
Practice Address - Street 1:1 BLACK STREET
Practice Address - Street 2:
Practice Address - City:ASHLEY
Practice Address - State:PA
Practice Address - Zip Code:18643
Practice Address - Country:US
Practice Address - Phone:570-823-7396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003957L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist