Provider Demographics
NPI:1679679385
Name:FICK, DANIEL J (MPT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:FICK
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 INNOVATION DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-8096
Mailing Address - Country:US
Mailing Address - Phone:724-343-4060
Mailing Address - Fax:724-343-4069
Practice Address - Street 1:21 S PINE ST
Practice Address - Street 2:HERITAGE MEDICAL CENTER
Practice Address - City:ELVERSON
Practice Address - State:PA
Practice Address - Zip Code:19520-9720
Practice Address - Country:US
Practice Address - Phone:610-286-0977
Practice Address - Fax:610-286-0986
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006501L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA409359OtherHIGHMARK BLUE SHIELD
PA134938OtherHEALTH AMER/HEALTH ASSUR.
PA0306737000OtherINDEPENDENCE BLUE CROSS
PA02990801OtherCAPITAL/KHPC
PA396749Medicare ID - Type UnspecifiedMEDICARE