Provider Demographics
NPI:1629673512
Name:PROKOP, JOHN E (LMT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:E
Last Name:PROKOP
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 S RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:OH
Mailing Address - Zip Code:44081-9670
Mailing Address - Country:US
Mailing Address - Phone:440-428-0444
Mailing Address - Fax:
Practice Address - Street 1:840 N LAKE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-2948
Practice Address - Country:US
Practice Address - Phone:440-428-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.013570225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist