Provider Demographics
NPI:1376896811
Name:REASBECK, PHILIP G (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:G
Last Name:REASBECK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9146
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:419 W PITTSBURGH ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2211
Practice Address - Country:US
Practice Address - Phone:724-837-5810
Practice Address - Fax:724-837-8938
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04994363A00000X
MDC04896363AM0700X
PAMA061531363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC186UXOtherBCBSNC
NC1376896811Medicaid
NC281340OtherMEDCOST
NC186UXOtherBCBSNC