Provider Demographics
NPI:1386115624
Name:SITKO, SCOTT A (LPTA)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:A
Last Name:SITKO
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2184 BELLE MEADE DR
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-2055
Mailing Address - Country:US
Mailing Address - Phone:810-922-0357
Mailing Address - Fax:
Practice Address - Street 1:1515 CAL DR
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-9016
Practice Address - Country:US
Practice Address - Phone:810-496-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502000925225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant