Provider Demographics
NPI:1710032503
Name:VASQUEZ, DAVID ROBERT (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ROBERT
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BRADWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-4221
Mailing Address - Country:US
Mailing Address - Phone:716-286-8744
Mailing Address - Fax:
Practice Address - Street 1:ATHLETICS OFFICE
Practice Address - Street 2:GALLAGHER CENTER
Practice Address - City:NIAGARA UNIVERSITY
Practice Address - State:NY
Practice Address - Zip Code:14109
Practice Address - Country:US
Practice Address - Phone:716-286-8744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0012092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer