Active NPI
Matthew Pettersen, LAT, ATC
- Athletic Trainer
- Shoreline, WA
National Provider Identifier
1073010526
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 810 NW 195TH St
Shoreline, WA 98177-2662 - Phone
- (205) 251-3747
- NPI assigned
- Apr 11, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Primary |
Addresses
Primary practice location
810 NW 195TH St
Shoreline, WA 98177-2662
Mailing address
1704 N State St
Bellingham, WA 98225-4605
Phone (360) 922-3120
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1523404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1555459200000",
"number": "1073010526",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1704 N STATE ST",
"city": "BELLINGHAM",
"state": "WA",
"postal_code": "982254605",
"telephone_number": "360-922-3120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "810 NW 195TH ST",
"city": "SHORELINE",
"state": "WA",
"postal_code": "981772662",
"telephone_number": "205-251-3747"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTERSEN",
"first_name": "MATTHEW",
"credential": "LAT, ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-04-11",
"last_updated": "2019-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shoreline, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.