Provider Demographics
NPI:1003244104
Name:SCOTT, JAMES II (LPTA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:SCOTT
Suffix:II
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 1:2147 BEAVER DAM RD
Mailing Address - Street 2:
Mailing Address - City:LUCEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39452-5659
Mailing Address - Country:US
Mailing Address - Phone:601-508-8276
Mailing Address - Fax:
Practice Address - Street 1:2147 BEAVER DAM RD
Practice Address - Street 2:
Practice Address - City:LUCEDALE
Practice Address - State:MS
Practice Address - Zip Code:39452-5659
Practice Address - Country:US
Practice Address - Phone:601-508-8276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2099726225200000X
MSPTA5112225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant