Basic Information
| Provider Information | |||||||||
| NPI: | 1174806624 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCOTT | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | ARCHIBALD | ||||||||
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| Credential: | DPT, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 147 W. 400 N | ||||||||
| Address2: | |||||||||
| City: | OREM | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012219071 | ||||||||
| FaxNumber: | 8012219071 | ||||||||
| Practice Location | |||||||||
| Address1: | 147 W 400 N | ||||||||
| Address2: | SUITE C | ||||||||
| City: | OREM | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840574658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012219060 | ||||||||
| FaxNumber: | 8012946917 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2011 | ||||||||
| LastUpdateDate: | 10/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 7960606-2401 | UT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.