Provider Demographics
NPI:1699185496
Name:STATZ, JOHN JACOB
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JACOB
Last Name:STATZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NORTHERN COLORADO ATHLETICS
Mailing Address - Street 2:270D BUTLER-HANCOCK ATHLETICS CENTER
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80639-0001
Mailing Address - Country:US
Mailing Address - Phone:970-351-1723
Mailing Address - Fax:970-351-4898
Practice Address - Street 1:NORTHERN COLORADO ATHLETICS
Practice Address - Street 2:270D BUTLER-HANCOCK ATHLETICS CENTER
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80639-0001
Practice Address - Country:US
Practice Address - Phone:970-351-1723
Practice Address - Fax:970-351-4898
Is Sole Proprietor?:No
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.00011072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer