Provider Demographics
NPI:1588784862
Name:WESTERMANN, SCOTT M (ATC)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:M
Last Name:WESTERMANN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
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Mailing Address - Street 1:8100 SCOTT AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-2322
Mailing Address - Country:US
Mailing Address - Phone:612-672-7105
Mailing Address - Fax:763-533-0833
Practice Address - Street 1:4080 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-5604
Practice Address - Country:US
Practice Address - Phone:612-672-7105
Practice Address - Fax:763-533-0833
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN10272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer