Basic Information
Provider Information
NPI: 1750598397
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DURFEE
FirstName: SCOTT
MiddleName: A
NamePrefix: MR.
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1565 SAXON BLVD
Address2: SUITE 301
City: DELTONA
State: FL
PostalCode: 327255876
CountryCode: US
TelephoneNumber: 3868510901
FaxNumber: 3868512426
Practice Location
Address1: 1565 SAXON BLVD
Address2: SUITE 301
City: DELTONA
State: FL
PostalCode: 327255876
CountryCode: US
TelephoneNumber: 3868510901
FaxNumber: 3868512426
Other Information
ProviderEnumerationDate: 05/16/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT22919FLY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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