Provider Demographics
NPI:1912319922
Name:PETERS, SCOTT (ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:PETERS
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 4TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-6206
Mailing Address - Country:US
Mailing Address - Phone:701-509-0209
Mailing Address - Fax:
Practice Address - Street 1:1608 4TH ST SW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-6206
Practice Address - Country:US
Practice Address - Phone:701-509-0209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-24
Last Update Date:2014-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer