Provider Demographics
NPI:1285286955
Name:SCOTT, STEPHANIE JO (PTA)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:JO
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1020 HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-1749
Mailing Address - Country:US
Mailing Address - Phone:706-712-9902
Mailing Address - Fax:
Practice Address - Street 1:1300 CLEO WAY
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8442
Practice Address - Country:US
Practice Address - Phone:706-226-5533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant