Provider Demographics
NPI:1205863354
Name:STASKO, BERNIE P (ATC)
Entity Type:Individual
Prefix:
First Name:BERNIE
Middle Name:P
Last Name:STASKO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 RAILROAD STREET
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:PA
Mailing Address - Zip Code:18220
Mailing Address - Country:US
Mailing Address - Phone:570-467-3008
Mailing Address - Fax:
Practice Address - Street 1:300 SCHUYLKILL MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3668
Practice Address - Country:US
Practice Address - Phone:570-621-9500
Practice Address - Fax:570-621-9510
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0030952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer