Provider Demographics
NPI:1689718058
Name:STECYK, SHANE DOUGLAS (ATC, CSCS)
Entity Type:Individual
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First Name:SHANE
Middle Name:DOUGLAS
Last Name:STECYK
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Gender:M
Credentials:ATC, CSCS
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Mailing Address - Street 1:210 N BELMONT ST
Mailing Address - Street 2:# 208
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4953
Mailing Address - Country:US
Mailing Address - Phone:818-291-1926
Mailing Address - Fax:818-677-3207
Practice Address - Street 1:18111 NORDHOFF ST
Practice Address - Street 2:DEPARTMENT OF KINESIOLOGY
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91330-8287
Practice Address - Country:US
Practice Address - Phone:818-677-4738
Practice Address - Fax:818-677-3207
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer