Provider Demographics
NPI:1801432430
Name:STAKER, JOSHUA ZAKHARY (MS, ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:ZAKHARY
Last Name:STAKER
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4137 RIDGEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-6223
Mailing Address - Country:US
Mailing Address - Phone:765-251-0556
Mailing Address - Fax:
Practice Address - Street 1:5185 3RD INFANTRY DIVISION RD
Practice Address - Street 2:
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905-5009
Practice Address - Country:US
Practice Address - Phone:765-251-0556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer