Provider Demographics
NPI:1265472559
Name:STACHURA, JOHN JOSEPH (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:STACHURA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 NIAGARA FALLS BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-9300
Mailing Address - Country:US
Mailing Address - Phone:716-836-2225
Mailing Address - Fax:716-836-2712
Practice Address - Street 1:1060 NIAGARA FALLS BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-9300
Practice Address - Country:US
Practice Address - Phone:716-836-2225
Practice Address - Fax:716-836-2712
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006675-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0065581OtherGHI
NY000610513001OtherCOMMUITY BLUE
NY01111215Medicaid
NY00011175401OtherUNIVERA