Provider Demographics
NPI:1003388539
Name:ALLEN-SCOTT, ELIZABETH KATE
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KATE
Last Name:ALLEN-SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 N MADISON ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47305-1812
Mailing Address - Country:US
Mailing Address - Phone:765-644-0500
Mailing Address - Fax:765-273-4379
Practice Address - Street 1:222 N MADISON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47305-1812
Practice Address - Country:US
Practice Address - Phone:765-644-0500
Practice Address - Fax:765-273-4379
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06005471A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant