Healthcare Provider Details

I. General information

NPI: 1871335968
Provider Name (Legal Business Name): DANIEL BARRETT STURCHAK ATC-LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RAM DR
MONONGAHELA PA
15063-3004
US

IV. Provider business mailing address

753 MARY ST
BENTLEYVILLE PA
15314-1016
US

V. Phone/Fax

Practice location:
  • Phone: 724-258-2200
  • Fax:
Mailing address:
  • Phone: 724-825-2042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: