Provider Demographics
NPI:1104046119
Name:SCULTHORP, SCOTT STEVEN (PTA)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:STEVEN
Last Name:SCULTHORP
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 1:209 SIGMA ST
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037-1441
Mailing Address - Country:US
Mailing Address - Phone:504-394-5560
Mailing Address - Fax:
Practice Address - Street 1:8128 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-7865
Practice Address - Country:US
Practice Address - Phone:225-791-8666
Practice Address - Fax:225-791-2891
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA1893225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant