Provider Demographics
NPI:1093822827
Name:SCOTT, KYLIE (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:
Other - Last Name:EILDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:416 1/2 S LEROUX ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-5632
Mailing Address - Country:US
Mailing Address - Phone:480-720-0557
Mailing Address - Fax:
Practice Address - Street 1:19389 N 59TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:623-537-6000
Practice Address - Fax:623-537-6017
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6875OtherLICENSE #