Provider Demographics
NPI:1851834808
Name:VANATTA, ROBERT JARROD (ATC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JARROD
Last Name:VANATTA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1269 BARCLAY CIR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-2903
Mailing Address - Country:US
Mailing Address - Phone:770-426-2772
Mailing Address - Fax:
Practice Address - Street 1:1269 BARCLAY CIR SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-2903
Practice Address - Country:US
Practice Address - Phone:770-426-2772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0020322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer