Basic Information
Provider Information
NPI: 1205933413
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SAWYER
FirstName: SCOT
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: PHYSICAL THERAPIST
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2415 PROFESSIONAL DR
Address2:  
City: ROCKY MOUNT
State: NC
PostalCode: 278042254
CountryCode: US
TelephoneNumber: 2524430808
FaxNumber: 2524519032
Practice Location
Address1: 3214 CHARLES B ROOT WYND STE 155
Address2:  
City: RALEIGH
State: NC
PostalCode: 276125440
CountryCode: US
TelephoneNumber: 9197817740
FaxNumber: 9197817743
Other Information
ProviderEnumerationDate: 09/20/2006
LastUpdateDate: 05/18/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X5203NCY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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