Provider Demographics
NPI:1841233426
Name:SEIDENBURG, MISTY L (DPT)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:L
Last Name:SEIDENBURG
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 1:120 N BALTIMORE ST
Mailing Address - Street 2:STE 110
Mailing Address - City:DILLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17019-1212
Mailing Address - Country:US
Mailing Address - Phone:717-502-3100
Mailing Address - Fax:717-502-3101
Practice Address - Street 1:120 N BALTIMORE ST
Practice Address - Street 2:STE 110
Practice Address - City:DILLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17019-1212
Practice Address - Country:US
Practice Address - Phone:717-502-3100
Practice Address - Fax:717-502-3101
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPT018022225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101677R9XMedicare Oscar/Certification