Provider Demographics
NPI:1841674819
Name:STUCK, DUSTIN JOSEPH (BS, ATC)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:JOSEPH
Last Name:STUCK
Suffix:
Gender:M
Credentials:BS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BARLEY LN
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078-3075
Mailing Address - Country:US
Mailing Address - Phone:717-679-5376
Mailing Address - Fax:
Practice Address - Street 1:19 BARLEY LN
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:PA
Practice Address - Zip Code:17078-3075
Practice Address - Country:US
Practice Address - Phone:717-679-5376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-19
Last Update Date:2015-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA20000217632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer