Basic Information
| Provider Information | |||||||||
| NPI: | 1558454868 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LONGMUIR | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PT, DPT, OCS, CSCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6040 W 84TH ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462781360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178022000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6040 W 84TH ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178022000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 07/20/2018 | ||||||||
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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 | 05008648A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 100133720K | 05 | IN | MEDICAID |