Provider Demographics
NPI:1881249696
Name:MYSLIWIEC, EVAN
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:MYSLIWIEC
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 1:115 PERRY HWY STE 136
Mailing Address - Street 2:
Mailing Address - City:HARMONY
Mailing Address - State:PA
Mailing Address - Zip Code:16037-9205
Mailing Address - Country:US
Mailing Address - Phone:724-452-1277
Mailing Address - Fax:724-452-0756
Practice Address - Street 1:4960 ALLISON PARK
Practice Address - Street 2:PA-8
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101-1510
Practice Address - Country:US
Practice Address - Phone:724-443-8060
Practice Address - Fax:724-443-8056
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT027891225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist