Provider Demographics
NPI:1194812636
Name:FORREST, SCOTT ERIK (PT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ERIK
Last Name:FORREST
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7541 9TH ST N
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-6626
Mailing Address - Country:US
Mailing Address - Phone:651-747-4328
Mailing Address - Fax:
Practice Address - Street 1:1700 TOWER DR W
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-7511
Practice Address - Country:US
Practice Address - Phone:651-439-8540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN280K0FOOtherBLUECROSS BLUESHIELD
MNHP41093OtherHEALTHPARTNERS
MN699465200Medicaid
WI40433300Medicaid
MN699465200Medicaid