Basic Information
Provider Information | |||||||||
NPI: | 1932275310 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PRUSHINSKI | ||||||||
FirstName: | MELISSA | ||||||||
MiddleName: | KATHERINE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MSPT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | LAZARSKI | ||||||||
OtherFirstName: | MELISSA | ||||||||
OtherMiddleName: | KATHERINE | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1086 ROUTE 315 | ||||||||
Address2: | PRO REHABILITATION SERVICES | ||||||||
City: | PLAINS | ||||||||
State: | PA | ||||||||
PostalCode: | 18702 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5708237761 | ||||||||
FaxNumber: | 5708228033 | ||||||||
Practice Location | |||||||||
Address1: | 1086 ROUTE 315 | ||||||||
Address2: |   | ||||||||
City: | PLAINS | ||||||||
State: | PA | ||||||||
PostalCode: | 18702 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5708237761 | ||||||||
FaxNumber: | 5708228033 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/28/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT012718L | PA | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 818036 | 01 |   | FIRST PRIORITY | OTHER | 1555187 | 01 |   | BLUE SHIELD | OTHER | 393538 | 01 |   | HEALTH AMERICA ASSURANCE | OTHER | 393539 | 01 |   | HEALTH AMERICA ASSURANCE | OTHER | 348556 | 01 |   | HEALTH AMERICA ASSURANCE | OTHER | 810397 | 01 |   | FIRST PRIORITY | OTHER | 818035 | 01 |   | FIRST PRIORITY | OTHER |