Provider Demographics
NPI:1366408825
Name:PIEKUTOSKI, MICHAEL D (MPT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:PIEKUTOSKI
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 1:715 BUSH DR
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-4821
Mailing Address - Country:US
Mailing Address - Phone:412-310-4009
Mailing Address - Fax:
Practice Address - Street 1:1800 WEST ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:PA
Practice Address - Zip Code:15120-2578
Practice Address - Country:US
Practice Address - Phone:412-476-8436
Practice Address - Fax:412-476-8439
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0109890225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA167651OtherBLUE CROSS