Provider Demographics
NPI:1013591668
Name:PASCUZZI, JOHN SALVATORE JR (ATC, LAT, OTC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SALVATORE
Last Name:PASCUZZI
Suffix:JR
Gender:M
Credentials:ATC, LAT, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-2641
Mailing Address - Country:US
Mailing Address - Phone:814-688-2918
Mailing Address - Fax:
Practice Address - Street 1:1968 HAWKS LN NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-2283
Practice Address - Country:US
Practice Address - Phone:404-778-7137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0034412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA