Basic Information
Provider Information
NPI: 1093320772
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCOTT
FirstName: LINDSEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DPT, ATC
OtherOrganizationName:  
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OtherLastName:  
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Mailing Information
Address1: 7581 9TH ST N STE 100
Address2:  
City: OAKDALE
State: MN
PostalCode: 551286635
CountryCode: US
TelephoneNumber: 6517484338
FaxNumber: 6517482892
Practice Location
Address1: 15160 FOLIAGE AVE STE 170
Address2:  
City: APPLE VALLEY
State: MN
PostalCode: 551245916
CountryCode: US
TelephoneNumber: 9526831745
FaxNumber: 9526831746
Other Information
ProviderEnumerationDate: 09/10/2020
LastUpdateDate: 10/02/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/02/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X11897MNY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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