Provider Demographics
NPI:1598016677
Name:ANDERSON, SCARLETT (PT)
Entity type:Individual
Prefix:
First Name:SCARLETT
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S WATAUGA AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-3546
Mailing Address - Country:US
Mailing Address - Phone:423-547-3840
Mailing Address - Fax:423-543-2655
Practice Address - Street 1:301 S WATAUGA AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-3546
Practice Address - Country:US
Practice Address - Phone:423-547-3840
Practice Address - Fax:423-543-2655
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5446225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist