Provider Demographics
NPI:1700042207
Name:TKACIK, HOLLY MICHELLE (DPT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:MICHELLE
Last Name:TKACIK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 CHESTER ST STE 5
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-3319
Mailing Address - Country:US
Mailing Address - Phone:855-583-3537
Mailing Address - Fax:855-966-4087
Practice Address - Street 1:160 PLAZA DR
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-6007
Practice Address - Country:US
Practice Address - Phone:814-762-8356
Practice Address - Fax:814-762-8366
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011634L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA130104Medicare Oscar/Certification