Provider Demographics
NPI:1629476569
Name:GAIZICK, RHONDA (PTA)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:GAIZICK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 FOWLER AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-3326
Mailing Address - Country:US
Mailing Address - Phone:570-759-2000
Mailing Address - Fax:570-585-1321
Practice Address - Street 1:500 FOWLER AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-3326
Practice Address - Country:US
Practice Address - Phone:570-759-2000
Practice Address - Fax:570-585-1321
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI000559174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist