Provider Demographics
NPI:1063032498
Name:WERK, JOSHUA (MAT, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:WERK
Suffix:
Gender:M
Credentials:MAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 HOWARD RD
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10996-1510
Mailing Address - Country:US
Mailing Address - Phone:320-815-9321
Mailing Address - Fax:
Practice Address - Street 1:639 HOWARD RD
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:NY
Practice Address - Zip Code:10996-1510
Practice Address - Country:US
Practice Address - Phone:320-815-9321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002580-12255A2300X
NY20000070432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer