Provider Demographics
NPI:1578570313
Name:TRISHMAN, DAVID ROSS (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ROSS
Last Name:TRISHMAN
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:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:PA
Mailing Address - Zip Code:18471-0517
Mailing Address - Country:US
Mailing Address - Phone:570-586-1614
Mailing Address - Fax:
Practice Address - Street 1:1333 MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:PECKVILLE
Practice Address - State:PA
Practice Address - Zip Code:18452-2039
Practice Address - Country:US
Practice Address - Phone:570-383-8841
Practice Address - Fax:570-383-8979
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002950L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
094274Q69OtherSTERLING OPTIONS I
167655OtherAMERI HEALTH
819438OtherFIRST PRIORITY HEALTH
9398532OtherCIGNA
167655OtherHIGHMARK BLUE SHIELD
819438OtherFIRST PRIORITY HEALTH