Provider Demographics
NPI:1326008798
Name:KISHA, DAVID THOMAS (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:THOMAS
Last Name:KISHA
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 1:430 INNOVATION DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-8096
Mailing Address - Country:US
Mailing Address - Phone:724-343-4060
Mailing Address - Fax:724-343-4069
Practice Address - Street 1:16515 POTTSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:PA
Practice Address - Zip Code:19526-8182
Practice Address - Country:US
Practice Address - Phone:484-660-3139
Practice Address - Fax:484-660-3373
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012979L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA339462OtherHIGHMARK BLUE SHIELD
PA50107119OtherCAPITAL BLUE CROSS
PA1026928760001Medicaid
PA1326008798OtherHEALTH AMERICA/HEALTH ASSURANCE
PA$$$$$$$$$OtherTRICARE
PA339462OtherHIGHMARK BLUE SHIELD