Healthcare Provider Details

I. General information

NPI: 1821675778
Provider Name (Legal Business Name): JOHN LUKE PRYOR PHD, ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 KIMBALL TOWER
BUFFALO NY
14214-8028
US

IV. Provider business mailing address

210 KIMBALL TOWER
BUFFALO NY
14214-8028
US

V. Phone/Fax

Practice location:
  • Phone: 716-829-5433
  • Fax:
Mailing address:
  • Phone: 716-829-5433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number003875
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: