Provider Demographics
NPI:1366487712
Name:SIVRICH, NICHOLAS A (PT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:A
Last Name:SIVRICH
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 1:1985 LINCOLN WAY
Mailing Address - Street 2:RAINBOW VILLAGE SHOPPING CENTER
Mailing Address - City:WHITE OAK
Mailing Address - State:PA
Mailing Address - Zip Code:15131-2418
Mailing Address - Country:US
Mailing Address - Phone:412-672-2352
Mailing Address - Fax:412-672-2657
Practice Address - Street 1:1985 LINCOLN WAY
Practice Address - Street 2:RAINBOW VILLAGE SHOPPING CENTER
Practice Address - City:WHITE OAK
Practice Address - State:PA
Practice Address - Zip Code:15131-2418
Practice Address - Country:US
Practice Address - Phone:412-672-2352
Practice Address - Fax:412-672-2657
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0157592225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA251570641OtherTAX ID
PA0015935850013Medicaid
PA251570641OtherTAX ID