Provider Demographics
NPI:1669432803
Name:STANTON, SEAN EVERETT (ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:EVERETT
Last Name:STANTON
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36026 RALEIGH DR
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70706-1530
Mailing Address - Country:US
Mailing Address - Phone:225-791-7724
Mailing Address - Fax:
Practice Address - Street 1:4100 BRONCO LN
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-3024
Practice Address - Country:US
Practice Address - Phone:225-658-7552
Practice Address - Fax:225-654-4298
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAATHJ003542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer