Basic Information
| Provider Information | |||||||||
| NPI: | 1477637825 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOOKHOUT | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | RICHARD | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3620 18TH AVE S | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554072810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125940591 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1935 COUNTY ROAD B2 W STE 405 | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551132797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516350578 | ||||||||
| FaxNumber: | 6516389380 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 10/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5994 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.