Provider Demographics
NPI:1427240670
Name:AZELTON, ROBERT PERRY III (ATC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:PERRY
Last Name:AZELTON
Suffix:III
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 1:700 E CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:MONETT
Mailing Address - State:MO
Mailing Address - Zip Code:65708-1436
Mailing Address - Country:US
Mailing Address - Phone:417-236-2480
Mailing Address - Fax:417-236-2481
Practice Address - Street 1:700 E CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-1436
Practice Address - Country:US
Practice Address - Phone:417-236-2480
Practice Address - Fax:417-236-2481
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010021722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer