Provider Demographics
NPI:1891794699
Name:MARKIEWICZ, DAVID JON (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JON
Last Name:MARKIEWICZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 STATE ST
Mailing Address - Street 2:SUITE 16
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1341
Mailing Address - Country:US
Mailing Address - Phone:814-480-7100
Mailing Address - Fax:814-480-7604
Practice Address - Street 1:TRAC REHAB EAST
Practice Address - Street 2:4403 IROQUOIS AVE
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16511
Practice Address - Country:US
Practice Address - Phone:814-877-7078
Practice Address - Fax:814-899-5484
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011745L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018836830005Medicaid
PAP00170264OtherRR MEDICARE
NY00026411501OtherUNIVERA
PA1361069OtherBLUE SHIELD
PA0018836830005Medicaid
PA078821E7CMedicare PIN