Provider Demographics
NPI:1356654396
Name:CHESLOCK, ANTHONY RICHARD (DPT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:RICHARD
Last Name:CHESLOCK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARCUS HOOK
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4513
Mailing Address - Country:US
Mailing Address - Phone:610-859-8850
Mailing Address - Fax:610-859-7876
Practice Address - Street 1:3400 ARAMINGO AVE
Practice Address - Street 2:SUITE 7A AND 7B
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4531
Practice Address - Country:US
Practice Address - Phone:215-203-1930
Practice Address - Fax:215-203-1931
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-020755225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30086183OtherKEYSTONE MERCY
PA2525888OtherHIGHMARK PA BLUE SHIELD
PA380542000OtherIBC
PA102526884-0001Medicaid
PA102526884-0001Medicaid