Provider Demographics
NPI:1053322883
Name:MCGOUGH, SCOTT FREDERICK (PT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:FREDERICK
Last Name:MCGOUGH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 W MAIN ST
Mailing Address - Street 2:STE 180
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3583
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:724 W MAIN ST STE 180
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3583
Practice Address - Country:US
Practice Address - Phone:972-434-6024
Practice Address - Fax:972-434-2784
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11164992251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83610TOtherBLUE CROSS PROVIDER NUMBE
TX1643306 01Medicaid
TX1643306 01Medicaid