Basic Information
| Provider Information | |||||||||
| NPI: | 1043341241 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCOTT | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MPT, CSCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102 LONNY CT | ||||||||
| Address2: | |||||||||
| City: | TOMS RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087535224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327408185 | ||||||||
| FaxNumber: | 7324401597 | ||||||||
| Practice Location | |||||||||
| Address1: | 1131 BROAD ST STE 301 | ||||||||
| Address2: | REGISTER PLAZA MEDICAL BUILDING | ||||||||
| City: | SHREWSBURY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077024329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7324401596 | ||||||||
| FaxNumber: | 7324401597 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA00966200 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.