Provider Demographics
NPI:1598122996
Name:MONSON, PAYTON ROBERT (ATS)
Entity Type:Individual
Prefix:
First Name:PAYTON
Middle Name:ROBERT
Last Name:MONSON
Suffix:
Gender:M
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 E GLYNN DR
Mailing Address - Street 2:
Mailing Address - City:PARKSTON
Mailing Address - State:SD
Mailing Address - Zip Code:57366-2031
Mailing Address - Country:US
Mailing Address - Phone:605-505-0558
Mailing Address - Fax:
Practice Address - Street 1:403 E GLYNN DR
Practice Address - Street 2:
Practice Address - City:PARKSTON
Practice Address - State:SD
Practice Address - Zip Code:57366-2031
Practice Address - Country:US
Practice Address - Phone:605-505-0558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD390200000XOtherATHLETIC TRAINING STUDENT