Provider Demographics
NPI:1134537939
Name:SLACHTISH, DAVID J
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:SLACHTISH
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 1:2741 BOULEVARD AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18509-1000
Mailing Address - Country:US
Mailing Address - Phone:570-344-6121
Mailing Address - Fax:570-344-5171
Practice Address - Street 1:2741 BOULEVARD AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-1000
Practice Address - Country:US
Practice Address - Phone:570-344-6121
Practice Address - Fax:570-344-5171
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI000456225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant