Provider Demographics
NPI:1215998265
Name:SUPRAK, DAVID N (MS, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:N
Last Name:SUPRAK
Suffix:
Gender:M
Credentials:MS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 PATTERSON ST
Mailing Address - Street 2:APT. 256
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2993
Mailing Address - Country:US
Mailing Address - Phone:541-346-7318
Mailing Address - Fax:
Practice Address - Street 1:2250 PATTERSON ST
Practice Address - Street 2:APT. 256
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2984
Practice Address - Country:US
Practice Address - Phone:541-346-7318
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer