Provider Demographics
NPI:1689612160
Name:CISEK, WILLIAM ROY (PT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROY
Last Name:CISEK
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 1059
Mailing Address - Street 2:20435 WASHINGTON ST
Mailing Address - City:ONLEY
Mailing Address - State:VA
Mailing Address - Zip Code:23418-1059
Mailing Address - Country:US
Mailing Address - Phone:757-789-3075
Mailing Address - Fax:757-789-3306
Practice Address - Street 1:20435 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ONLEY
Practice Address - State:VA
Practice Address - Zip Code:23418-1059
Practice Address - Country:US
Practice Address - Phone:757-789-3075
Practice Address - Fax:757-789-3306
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202753225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist