Provider Demographics
NPI:1396204087
Name:PECJAK, ANTHONY M
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:M
Last Name:PECJAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 TAYLORTOWN RD LOT 4
Mailing Address - Street 2:
Mailing Address - City:DILLINER
Mailing Address - State:PA
Mailing Address - Zip Code:15327-3600
Mailing Address - Country:US
Mailing Address - Phone:724-886-8571
Mailing Address - Fax:
Practice Address - Street 1:51 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-1258
Practice Address - Country:US
Practice Address - Phone:724-628-8191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer