Provider Demographics
NPI:1538379268
Name:MISCAVIGE, JOANNA HALINA (PT)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:HALINA
Last Name:MISCAVIGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 WHITE DAWN LN
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-5334
Mailing Address - Country:US
Mailing Address - Phone:717-458-5521
Mailing Address - Fax:
Practice Address - Street 1:231 CROWE AVENUE
Practice Address - Street 2:
Practice Address - City:MARS
Practice Address - State:PA
Practice Address - Zip Code:16046
Practice Address - Country:US
Practice Address - Phone:724-625-4280
Practice Address - Fax:724-625-4288
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008706E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist