Provider Demographics
NPI:1144212242
Name:MISHOCK, JOHN RICHARD (MPT DC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RICHARD
Last Name:MISHOCK
Suffix:
Gender:M
Credentials:MPT DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 SWAMP PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19525-9307
Mailing Address - Country:US
Mailing Address - Phone:610-327-2600
Mailing Address - Fax:610-327-9050
Practice Address - Street 1:1806 SWAMP PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:GILBERTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19525-9307
Practice Address - Country:US
Practice Address - Phone:610-327-2600
Practice Address - Fax:610-327-9050
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006576L111N00000X
PAPT012572L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1962428391OtherGROUP NPI
PA694511OtherHIGHMARK
PAMI506229OtherDC-HIGHMARK
PA0449992000OtherKEYSTONE HEALTH PLAN EAST
PA0264322000OtherDC-KHPE
PA0264322000OtherDC-PERSONAL CHOICE
PA38300034OtherDC-AETNA
PA0449992000OtherPERSONAL CHOICE
PA1962428391OtherGROUP NPI