Provider Demographics
NPI:1245319052
Name:SEGERS, DUSTIN SHELTON (ATC-L)
Entity type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:SHELTON
Last Name:SEGERS
Suffix:
Gender:M
Credentials:ATC-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 NORTHLINE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7616
Mailing Address - Country:US
Mailing Address - Phone:336-544-3900
Mailing Address - Fax:336-544-3939
Practice Address - Street 1:3200 NORTHLINE AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7616
Practice Address - Country:US
Practice Address - Phone:336-544-3900
Practice Address - Fax:336-544-3939
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC04492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer