Provider Demographics
NPI:1649391228
Name:SIPERKO, RICHARD THOMAS (MPT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:THOMAS
Last Name:SIPERKO
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 KRYCH ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-2605
Mailing Address - Country:US
Mailing Address - Phone:570-714-5128
Mailing Address - Fax:
Practice Address - Street 1:1546 HIGHWAY 315
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-7005
Practice Address - Country:US
Practice Address - Phone:570-819-5650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012127L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist