Provider Demographics
NPI:1962707448
Name:DEIHL, SCOTT MATTHEW (ATC, PTA)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:MATTHEW
Last Name:DEIHL
Suffix:
Gender:M
Credentials:ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 UNIVERSITY DRIVE, EC 130
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0859
Mailing Address - Country:US
Mailing Address - Phone:717-531-8070
Mailing Address - Fax:717-531-0138
Practice Address - Street 1:500 UNIVERSITY DRIVE, EC 130
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-0859
Practice Address - Country:US
Practice Address - Phone:717-531-8070
Practice Address - Fax:717-531-0138
Is Sole Proprietor?:No
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE002117L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant