Provider Demographics
NPI:1881681468
Name:RASICCI, DAVID JAMES (LPT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JAMES
Last Name:RASICCI
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1569 SMITH TOWNSHIP STATE RD
Mailing Address - Street 2:P.O. BOX 297
Mailing Address - City:ATLASBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15004
Mailing Address - Country:US
Mailing Address - Phone:724-947-9999
Mailing Address - Fax:724-947-2291
Practice Address - Street 1:1569 SMITH TOWNSHIP STATE RD
Practice Address - Street 2:
Practice Address - City:ATLASBURG
Practice Address - State:PA
Practice Address - Zip Code:15004
Practice Address - Country:US
Practice Address - Phone:724-947-9999
Practice Address - Fax:724-947-2291
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT001148E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA485432Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER