Provider Demographics
NPI:1043244734
Name:WILLIAMS, SCOTT MASTON (ATC, CSCS, LMT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:MASTON
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:ATC, CSCS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6308
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-1003
Mailing Address - Country:US
Mailing Address - Phone:850-305-9127
Mailing Address - Fax:
Practice Address - Street 1:123 HWY98
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-1003
Practice Address - Country:US
Practice Address - Phone:850-305-9127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL36952255A2300X
FLMA41969225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC3880OtherBLUE CROSS/BLUE SHIELD
FL1043244734OtherNPI-NATIONAL PLAN & PROVIDER ENUMERATION SYSTEM