Provider Demographics
NPI:1821675778
Name:PRYOR, JOHN LUKE (PHD, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LUKE
Last Name:PRYOR
Suffix:
Gender:M
Credentials:PHD, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 KIMBALL TOWER
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-8028
Mailing Address - Country:US
Mailing Address - Phone:716-829-5433
Mailing Address - Fax:
Practice Address - Street 1:210 KIMBALL TOWER
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-8028
Practice Address - Country:US
Practice Address - Phone:716-829-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0038752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer