Provider Demographics
NPI:1841404696
Name:PRASIFKA, AARON
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:PRASIFKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 FM 1304
Mailing Address - Street 2:
Mailing Address - City:ABBOTT
Mailing Address - State:TX
Mailing Address - Zip Code:76621-3227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:307 S BOSQUE ST
Practice Address - Street 2:
Practice Address - City:WHITNEY
Practice Address - State:TX
Practice Address - Zip Code:76692-2706
Practice Address - Country:US
Practice Address - Phone:254-694-7589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2055263OtherLICENSE#