Provider Demographics
NPI:1477523751
Name:MUZALEWSKI, ADAM (PT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:MUZALEWSKI
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 1:112 FREEDOM COURT
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:RTE. 209
Practice Address - Street 2:HC#1 BOX 110
Practice Address - City:BRODHEADSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18322-9532
Practice Address - Country:US
Practice Address - Phone:570-992-4400
Practice Address - Fax:570-992-5262
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT010711L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2125286000OtherINDEPENDENCE BLUE SHEILD
PA50056180OtherCAPITAL BLUE CROSS
PA7129458OtherAETNA
PA819953OtherFIRST PRIORITY HEALTH
PA1441422OtherBLUE SHIELD