Provider Demographics
NPI:1932152022
Name:STASZAK, MICHAEL (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:STASZAK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5571
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-0571
Mailing Address - Country:US
Mailing Address - Phone:541-505-8180
Mailing Address - Fax:541-505-7134
Practice Address - Street 1:488 E 11TH AVE
Practice Address - Street 2:STE 150A
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3601
Practice Address - Country:US
Practice Address - Phone:541-505-8180
Practice Address - Fax:541-505-7134
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist