Provider Demographics
NPI:1659308815
Name:DRISKO, JONATHAN D (ATC)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:D
Last Name:DRISKO
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 1:108 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01581-3019
Mailing Address - Country:US
Mailing Address - Phone:508-366-7602
Mailing Address - Fax:
Practice Address - Street 1:79 BARTLETT ST
Practice Address - Street 2:
Practice Address - City:NORTHBORO
Practice Address - State:MA
Practice Address - Zip Code:01532-1657
Practice Address - Country:US
Practice Address - Phone:508-351-7010
Practice Address - Fax:508-351-7005
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
MAAT-11502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer