Active NPI
Stephanie Petery
- Athletic Trainer
- Athens, OH
National Provider Identifier
1477173870
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT006172
- Practice address
- 363 Richland Ave Apt 274
Athens, OH 45701-3281 - Phone
- (610) 639-6566
- NPI assigned
- Apr 26, 2020
- Last updated
- Jul 10, 2020
- Sex
- Female
- Sole proprietor
- No
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 | AT006172 | OH | Primary |
Addresses
Primary practice location
363 Richland Ave Apt 274
Athens, OH 45701-3281
Mailing address
363 Richland Ave Apt 274
Athens, OH 45701-3281
Phone (610) 639-6566
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT006172 | OH | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1587859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594339200000",
"number": "1477173870",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "363 RICHLAND AVE APT 274",
"city": "ATHENS",
"state": "OH",
"postal_code": "457013281",
"telephone_number": "610-639-6566"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "363 RICHLAND AVE APT 274",
"city": "ATHENS",
"state": "OH",
"postal_code": "457013281",
"telephone_number": "610-639-6566"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERY",
"first_name": "STEPHANIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-04-26",
"last_updated": "2020-07-10",
"certification_date": "2020-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "OH",
"license": "AT006172",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Athens, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.