Basic Information
| Provider Information | |||||||||
| NPI: | 1487844361 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRIGGS | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | RR 1 BOX 140C | ||||||||
| Address2: | |||||||||
| City: | TOWANDA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 188489787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702651111 | ||||||||
| FaxNumber: | 5702657134 | ||||||||
| Practice Location | |||||||||
| Address1: | 239 NORTHERN BLVD | ||||||||
| Address2: | |||||||||
| City: | CLARKS SUMMIT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184119302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705872142 | ||||||||
| FaxNumber: | 5705871978 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2007 | ||||||||
| LastUpdateDate: | 03/26/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT018928 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1990391 | 01 | PA | BLUE SHIELD | OTHER | 9553096 | 01 | PA | AETNA | OTHER | 822755 | 01 | FIRST PRIORITY HEALTH | OTHER |