Provider Demographics
NPI:1043341241
Name:SCOTT, KEVIN JAMES (MPT, CSCS)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JAMES
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 LONNY CT
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-5224
Mailing Address - Country:US
Mailing Address - Phone:732-740-8185
Mailing Address - Fax:732-440-1597
Practice Address - Street 1:1131 BROAD ST STE 301
Practice Address - Street 2:REGISTER PLAZA MEDICAL BUILDING
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4329
Practice Address - Country:US
Practice Address - Phone:732-440-1596
Practice Address - Fax:732-440-1597
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00966200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist