Provider Demographics
NPI:1083776918
Name:SCOTT, KEITH M (PT, MPT)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:M
Last Name:SCOTT
Suffix:
Gender:M
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BUNKER HILL PL
Mailing Address - Street 2:
Mailing Address - City:WHIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07981-2216
Mailing Address - Country:US
Mailing Address - Phone:201-572-1012
Mailing Address - Fax:
Practice Address - Street 1:565 ROUTE 10
Practice Address - Street 2:
Practice Address - City:WHIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07981-1513
Practice Address - Country:US
Practice Address - Phone:201-572-1012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00750300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
10669911OtherCAQH
NJ046242Medicare PIN