Provider Demographics
NPI:1992145494
Name:HOWELL, PETER DAVID (LAT,ATC)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:DAVID
Last Name:HOWELL
Suffix:
Gender:M
Credentials:LAT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 S ELMIRA ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:PA
Mailing Address - Zip Code:18810-1118
Mailing Address - Country:US
Mailing Address - Phone:570-886-8729
Mailing Address - Fax:
Practice Address - Street 1:308 S ELMIRA ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:PA
Practice Address - Zip Code:18810-1118
Practice Address - Country:US
Practice Address - Phone:570-886-8729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART002411A2255A2300X
NY001064-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer