Provider Demographics
NPI:1821254301
Name:CIECWISZ, JESSICA LYNN (PT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:CIECWISZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:CHURETTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2775 SCHOENERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7307
Mailing Address - Country:US
Mailing Address - Phone:610-861-8080
Mailing Address - Fax:610-807-0366
Practice Address - Street 1:2775 SCHOENERSVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7307
Practice Address - Country:US
Practice Address - Phone:610-861-8080
Practice Address - Fax:610-807-0366
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019399225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2059618OtherHIGHMARK BLUE SHIELD
3536366000OtherKEYSTONE HEALTH PLAN EAST
50079517OtherKEYSTONE HEALTH PLAN CENTRAL
1960285OtherAETNA HMO
2936928OtherUNITED HEALTHCARE
50079517OtherCAPITAL BLUE CROSS
9881184OtherAETNA PPO
3536366000OtherAMERIHEALTH
3536366000OtherINDEPENDENCE BLUE CROSS
1568025OtherGATEWAY HEALTH PLAN
47241OtherGEISINGER HEALTH PLAN
1855464OtherCIGNA HEALTHCARE
3536366000OtherINDEPENDENCE BLUE CROSS