Provider Demographics
NPI:1154856011
Name:PROSEK, JOHN MURRAY (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MURRAY
Last Name:PROSEK
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28710 LINE 26 RD
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-9129
Mailing Address - Country:US
Mailing Address - Phone:956-454-8381
Mailing Address - Fax:
Practice Address - Street 1:1201 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-4362
Practice Address - Country:US
Practice Address - Phone:956-577-0041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT19612255A2300X
OH0994024782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer