Provider Demographics
NPI:1225820723
Name:PLAVCHAK, MARISSA E
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:E
Last Name:PLAVCHAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 BOULDER RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1813
Mailing Address - Country:US
Mailing Address - Phone:412-874-4913
Mailing Address - Fax:
Practice Address - Street 1:580 REED RD STE 3
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3655
Practice Address - Country:US
Practice Address - Phone:610-356-6211
Practice Address - Fax:610-356-1429
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI006075225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant