Provider Demographics
NPI:1063714202
Name:DANCHO, JEROME JOHN (ATC)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:JOHN
Last Name:DANCHO
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 1:67 N 10TH ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-1725
Mailing Address - Country:US
Mailing Address - Phone:570-213-2663
Mailing Address - Fax:
Practice Address - Street 1:67 N 10TH ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1725
Practice Address - Country:US
Practice Address - Phone:570-213-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-20
Last Update Date:2010-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer