Provider Demographics
NPI:1821647355
Name:ZACHESKY, NATHAN JOSEPH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:JOSEPH
Last Name:ZACHESKY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 22ND STREET
Mailing Address - Street 2:PO BOX 206
Mailing Address - City:NORTHERN CAMBRIA
Mailing Address - State:PA
Mailing Address - Zip Code:15714
Mailing Address - Country:US
Mailing Address - Phone:814-421-8400
Mailing Address - Fax:
Practice Address - Street 1:2910 BIGLER AVE
Practice Address - Street 2:
Practice Address - City:NORTHERN CAMBRIA
Practice Address - State:PA
Practice Address - Zip Code:15714
Practice Address - Country:US
Practice Address - Phone:814-948-5165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-07
Last Update Date:2019-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT027939225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0Medicaid