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NPI Code Detail

MEDICARE: SCOTT CROTHERS ATC

MEDICARE: SCOTT CROTHERS ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer1070SC

General Provider Information

NPI Number : 1881074037
Entity Type Code : Individual
Provider Name (Legal Business Name) : SCOTT CROTHERS ATC
Provider Business Mailing Address
First Line : 9200 UNIVERSITY BLVD
Second Line : CHARLESTON SOUTHERN UNIVERSITY
City : NORTH CHARLESTON
State : SC
Zip : 29406-9121
Country : US
Telephone Number : 843-863-7683
Fax Number :
Provider Business Practice Location Address
First Line : 9200 UNIVERSITY BLVD
Second Line : CHARLESTON SOUTHERN UNIVERSITY ATHLETIC TRAINING
City : NORTH CHARLESTON
State : SC
Zip : 29406-9121
Country : US
Telephone Number : 843-863-7683
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2015
Last Update Date : 06/03/2015

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