Provider Demographics
NPI:1659578722
Name:HISLE, PETER (PT)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:HISLE
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 1:945 JUNIPER RD
Mailing Address - Street 2:
Mailing Address - City:HELLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18055-1914
Mailing Address - Country:US
Mailing Address - Phone:917-916-7146
Mailing Address - Fax:
Practice Address - Street 1:945 JUNIPER RD
Practice Address - Street 2:
Practice Address - City:HELLERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18055-1914
Practice Address - Country:US
Practice Address - Phone:917-916-7146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017888225100000X
NY015094-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist