Provider Demographics
NPI:1265447924
Name:TENNIS, SCOTT DANIEL (PT)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:DANIEL
Last Name:TENNIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-0179
Mailing Address - Country:US
Mailing Address - Phone:410-676-6767
Mailing Address - Fax:410-676-6770
Practice Address - Street 1:1411 S MOUNTAIN RD STE D
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-3202
Practice Address - Country:US
Practice Address - Phone:410-676-6767
Practice Address - Fax:410-676-6770
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19706225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist