Provider Demographics
NPI:1750416749
Name:ENTRIKEN, JOHN (ATC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ENTRIKEN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 N KEMP ST
Mailing Address - Street 2:
Mailing Address - City:KUTZTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19530-1241
Mailing Address - Country:US
Mailing Address - Phone:610-683-6748
Mailing Address - Fax:
Practice Address - Street 1:15200 KUTZTOWN RD
Practice Address - Street 2:KUTZTOWN SPORTS MEDICINE
Practice Address - City:KUTZTOWN
Practice Address - State:PA
Practice Address - Zip Code:19530-9335
Practice Address - Country:US
Practice Address - Phone:610-683-4085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART000660A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer