Active NPI
Justin Douglas Peters, LAT, ATC
- Athletic Trainer
- Bradenton, FL
National Provider Identifier
1750871174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AL1083
- Practice address
- 6130 39TH CT E
Bradenton, FL 34203-7002 - Phone
- (941) 544-8089
- NPI assigned
- May 10, 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 | AL1083 | FL | Primary |
Addresses
Primary practice location
6130 39TH CT E
Bradenton, FL 34203-7002
Mailing address
6130 39TH CT E
Bradenton, FL 34203-7002
Phone (941) 544-8089
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 |
|---|---|---|---|
| AL1083 | FL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525910400000",
"number": "1750871174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6130 39TH CT E",
"city": "BRADENTON",
"state": "FL",
"postal_code": "342037002",
"telephone_number": "941-544-8089"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6130 39TH CT E",
"city": "BRADENTON",
"state": "FL",
"postal_code": "342037002",
"telephone_number": "941-544-8089"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERS",
"first_name": "JUSTIN",
"middle_name": "DOUGLAS",
"credential": "LAT, ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-05-10",
"last_updated": "2018-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "FL",
"license": "AL1083",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bradenton, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.