Provider Demographics
NPI:1821532144
Name:BLASKIEWICZ, MARCIE ANN (DPT)
Entity Type:Individual
Prefix:DR
First Name:MARCIE
Middle Name:ANN
Last Name:BLASKIEWICZ
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 1:1095 TEXAS PALMYRA HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-7687
Mailing Address - Country:US
Mailing Address - Phone:570-616-0665
Mailing Address - Fax:570-616-0669
Practice Address - Street 1:1095 TEXAS PALMYRA HWY STE 1
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-7687
Practice Address - Country:US
Practice Address - Phone:570-616-0665
Practice Address - Fax:570-616-0669
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA023393225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032684160002Medicaid