Provider Demographics
NPI:1427407915
Name:PRIESTAS, MICHAEL (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:PRIESTAS
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 1:23 FITNESS LN
Mailing Address - Street 2:
Mailing Address - City:BERKELEY SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:25411-7080
Mailing Address - Country:US
Mailing Address - Phone:304-258-1300
Mailing Address - Fax:304-258-1400
Practice Address - Street 1:19336 LEITERSBURG PIKE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-1436
Practice Address - Country:US
Practice Address - Phone:304-258-1300
Practice Address - Fax:304-258-1400
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT003633225100000X
MD25986225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist