Provider Demographics
NPI:1518374172
Name:ZALESKI, EDWARD (PTA)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:ZALESKI
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 PRIMROSE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING BROOK TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18444-6404
Mailing Address - Country:US
Mailing Address - Phone:570-842-1636
Mailing Address - Fax:
Practice Address - Street 1:370 WHITESTONE COR
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-7193
Practice Address - Country:US
Practice Address - Phone:570-476-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1003818225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant