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General NPI Number Information
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NPI Number | 1669432803
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Entity Type | Individual
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Provider Name | SEAN EVERETT STANTON ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4100 BRONCO LN
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City | ZACHARY
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State | LA
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Zip | 70791-3024
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Country | US
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Telephone | 225-658-7552
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Fax | 225-654-4298
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Provider Business Mailing Address
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Address Line | 36026 RALEIGH DR
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City | DENHAM SPRINGS
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State | LA
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Zip | 70706-1530
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Country | US
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Telephone | 225-791-7724
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | ATHJ00354
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License Number State | LA
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