Provider Demographics
NPI:1548700503
Name:PASHKEVICH, BRIAN (ATC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:PASHKEVICH
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 1:308 WARHAWK WAY
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71209-0001
Mailing Address - Country:US
Mailing Address - Phone:908-930-1163
Mailing Address - Fax:
Practice Address - Street 1:308 WARHAWK WAY
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71209-0001
Practice Address - Country:US
Practice Address - Phone:908-930-1163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAATH.2004322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer