Provider Demographics
NPI:1023331998
Name:HAERTEL, SCOTT ROBERT (MS, ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ROBERT
Last Name:HAERTEL
Suffix:
Gender:M
Credentials:MS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 BLUE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CARPENTERSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60110-3601
Mailing Address - Country:US
Mailing Address - Phone:702-217-5505
Mailing Address - Fax:
Practice Address - Street 1:3420 BLUE RIDGE DR
Practice Address - Street 2:
Practice Address - City:CARPENTERSVILLE
Practice Address - State:IL
Practice Address - Zip Code:60110-3601
Practice Address - Country:US
Practice Address - Phone:702-217-5505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960009972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer