Provider Demographics
NPI:1215934518
Name:RADOMSKI, SCOTT (MSPT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:RADOMSKI
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9664 E DAVENPORT DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1426
Mailing Address - Country:US
Mailing Address - Phone:480-332-3472
Mailing Address - Fax:516-977-0799
Practice Address - Street 1:9664 E DAVENPORT DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1426
Practice Address - Country:US
Practice Address - Phone:480-332-3472
Practice Address - Fax:480-383-6077
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4399225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP29540Medicare UPIN
AZ65087Medicare ID - Type Unspecified
AZ75147Medicare PIN