Provider Demographics
NPI:1093023186
Name:MORRIS, SCOTT GLENN (PTA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:GLENN
Last Name:MORRIS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 E MAIN APT AA301
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-6793
Mailing Address - Country:US
Mailing Address - Phone:253-241-3566
Mailing Address - Fax:
Practice Address - Street 1:1715 E MAIN APT AA301
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-6793
Practice Address - Country:US
Practice Address - Phone:253-241-3566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP1 60039657225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant