Provider Demographics
NPI:1851328975
Name:GRAVATT, SCOTT R (MS, VATL, ATC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:R
Last Name:GRAVATT
Suffix:
Gender:M
Credentials:MS, VATL, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 BLACKBERRY LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-4854
Mailing Address - Country:US
Mailing Address - Phone:540-760-5358
Mailing Address - Fax:
Practice Address - Street 1:12301 SPOTSWOOD FURNACE RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-2208
Practice Address - Country:US
Practice Address - Phone:540-548-4051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer