Provider Demographics
NPI:1114104387
Name:SCOTT, SUSAN L (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:L
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:L
Other - Last Name:HOLTHAUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:17700 W CAPITOL DR STOP 6
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-2080
Mailing Address - Country:US
Mailing Address - Phone:622-781-3083
Mailing Address - Fax:
Practice Address - Street 1:17700 W CAPITOL DR STOP 6
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045
Practice Address - Country:US
Practice Address - Phone:262-781-8352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist