Provider Demographics
NPI:1841439973
Name:RUSNAK, ELIZABETH JEAN (PTA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JEAN
Last Name:RUSNAK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 EDNA ST
Mailing Address - Street 2:
Mailing Address - City:EAST MC KEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15035-1008
Mailing Address - Country:US
Mailing Address - Phone:412-824-1703
Mailing Address - Fax:
Practice Address - Street 1:5609 5TH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-2601
Practice Address - Country:US
Practice Address - Phone:412-362-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1001997225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant