Provider Demographics
NPI:1134114648
Name:ANDRASCIK, RICHARD S (MS PT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:S
Last Name:ANDRASCIK
Suffix:
Gender:M
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MARKET ST STE 103
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2998
Mailing Address - Country:US
Mailing Address - Phone:724-728-7550
Mailing Address - Fax:724-728-6448
Practice Address - Street 1:500 MARKET ST STE 103
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2998
Practice Address - Country:US
Practice Address - Phone:724-728-7550
Practice Address - Fax:724-728-6448
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003405L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA650024521OtherRAILROAD MEDICARE
PACK4547OtherMEDICARE RAILROAD
PA00119933310002Medicaid
PA435919QYHOtherHIGHMARK
PA4572646OtherAETNA
PA4572646OtherAETNA
SCQ332446679Medicare PIN