Provider Demographics
NPI:1649243817
Name:STANSBURY, SCOTT ROBERT (MA, ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ROBERT
Last Name:STANSBURY
Suffix:
Gender:M
Credentials:MA, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9880 SHORE BREAK LN APT 103
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-2991
Mailing Address - Country:US
Mailing Address - Phone:574-340-3089
Mailing Address - Fax:
Practice Address - Street 1:1101 CAMDEN AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-6860
Practice Address - Country:US
Practice Address - Phone:410-543-6355
Practice Address - Fax:574-631-3305
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001465A246Z00000X
MDA00014012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other