Provider Demographics
NPI:1033178678
Name:SCOTT, LONI SPENCER (DPT)
Entity Type:Individual
Prefix:
First Name:LONI
Middle Name:SPENCER
Last Name:SCOTT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LONI
Other - Middle Name:
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7321 11TH ST
Mailing Address - Street 2:
Mailing Address - City:HILL AFB
Mailing Address - State:UT
Mailing Address - Zip Code:84056-5012
Mailing Address - Country:US
Mailing Address - Phone:801-777-5400
Mailing Address - Fax:
Practice Address - Street 1:7321 11TH ST
Practice Address - Street 2:
Practice Address - City:HILL AFB
Practice Address - State:UT
Practice Address - Zip Code:84056-5012
Practice Address - Country:US
Practice Address - Phone:801-777-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4797211-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTQ17039Medicare UPIN
UT005700804Medicare ID - Type Unspecified