Provider Demographics
NPI:1245215813
Name:PLISKY, PHILLIP (DPT, ATC, CSCS, OCS)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:PLISKY
Suffix:
Gender:M
Credentials:DPT, ATC, CSCS, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 E INDIANA ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-2794
Mailing Address - Country:US
Mailing Address - Phone:812-476-0409
Mailing Address - Fax:812-476-1016
Practice Address - Street 1:533 W COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1617
Practice Address - Country:US
Practice Address - Phone:812-759-3001
Practice Address - Fax:812-401-9013
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05006207A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000302815OtherBLUE CROSS BLUE SHIELD
IN200829430Medicaid
IN200829430Medicaid
IN216070RRMedicare PIN