Provider Demographics
NPI:1396970851
Name:DEITS, JEFFREY SCOTT (MA, ATC, CSCS, CES,)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SCOTT
Last Name:DEITS
Suffix:
Gender:M
Credentials:MA, ATC, CSCS, CES,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7753 SUMMIT ROCK PT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-8956
Mailing Address - Country:US
Mailing Address - Phone:303-669-2733
Mailing Address - Fax:
Practice Address - Street 1:7753 SUMMIT ROCK PT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-8956
Practice Address - Country:US
Practice Address - Phone:303-669-2733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0028622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer