Provider Demographics
NPI:1548280621
Name:STOKLOSA, DAVID ALLEN (ATC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALLEN
Last Name:STOKLOSA
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 1:1757 BERNSTEIN DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-6977
Mailing Address - Country:US
Mailing Address - Phone:757-301-7196
Mailing Address - Fax:
Practice Address - Street 1:6330 NEWTOWN RD STE 109
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4803
Practice Address - Country:US
Practice Address - Phone:757-466-4401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0126000615174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist