Provider Demographics
NPI:1942849641
Name:VENCKUS, SEAN M (ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:M
Last Name:VENCKUS
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 ASTORIA LN SE
Mailing Address - Street 2:
Mailing Address - City:GURLEY
Mailing Address - State:AL
Mailing Address - Zip Code:35748-0801
Mailing Address - Country:US
Mailing Address - Phone:703-656-6886
Mailing Address - Fax:
Practice Address - Street 1:205 SPRAGINS HALL
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35899-0001
Practice Address - Country:US
Practice Address - Phone:703-656-6886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty