Provider Demographics
NPI:1003825969
Name:DECIANTIS, SCOTT ANTHONY (ATC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ANTHONY
Last Name:DECIANTIS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3428 WESTMONT DR
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-2969
Mailing Address - Country:US
Mailing Address - Phone:803-439-1677
Mailing Address - Fax:803-641-3723
Practice Address - Street 1:471 UNIVERSITY PARKWAY
Practice Address - Street 2:USCA ATEP
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801
Practice Address - Country:US
Practice Address - Phone:803-641-3207
Practice Address - Fax:803-641-3723
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer