Provider Demographics
NPI:1407496789
Name:SCRUGGS, IAN (MA, ATC, LAT, CSCS,)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:SCRUGGS
Suffix:
Gender:M
Credentials:MA, ATC, LAT, CSCS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18034 BECKET DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3929
Mailing Address - Country:US
Mailing Address - Phone:203-982-6063
Mailing Address - Fax:
Practice Address - Street 1:18034 BECKET DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3929
Practice Address - Country:US
Practice Address - Phone:203-982-6063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.00021132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer