Provider Demographics
NPI:1720031123
Name:CIESLIK, MARTA (MSPT)
Entity Type:Individual
Prefix:MS
First Name:MARTA
Middle Name:
Last Name:CIESLIK
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 JOLIET ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1996
Mailing Address - Country:US
Mailing Address - Phone:219-864-3300
Mailing Address - Fax:219-864-2569
Practice Address - Street 1:1100 JOLIET ST
Practice Address - Street 2:SUITE 205
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1996
Practice Address - Country:US
Practice Address - Phone:219-864-3300
Practice Address - Fax:219-864-2569
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008826A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN214710QMedicare ID - Type UnspecifiedGROUP NUMBER WITH SUFFIX
IN214680SMedicare ID - Type UnspecifiedGROUP NUMBER WITH SUFFIX
IN214690SMedicare ID - Type UnspecifiedGROUP NUMBER WITH SUFFIX