Provider Demographics
NPI:1912071168
Name:SCOTT, RUTH ELLEN (PT)
Entity type:Individual
Prefix:MS
First Name:RUTH
Middle Name:ELLEN
Last Name:SCOTT
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 1:1407 E CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-2602
Mailing Address - Country:US
Mailing Address - Phone:605-624-7246
Mailing Address - Fax:605-624-7177
Practice Address - Street 1:1407 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-2602
Practice Address - Country:US
Practice Address - Phone:605-624-7246
Practice Address - Fax:605-624-7177
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0849225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD51420OtherSIOUX VALLEY HEALTH PLAN
SD12316OtherAVERA HEALTH PLANS
SD0040237OtherWELLMARK BCBS
SD5833480Medicaid
SDPT0849OtherDAKOTACARE
SD5833480Medicaid