Provider Demographics
NPI:1114464021
Name:SCANDLYN, JUDSON DYLAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JUDSON
Middle Name:DYLAN
Last Name:SCANDLYN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-8907
Mailing Address - Fax:423-362-8684
Practice Address - Street 1:2497 S ROANE ST
Practice Address - Street 2:STE 220
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-8670
Practice Address - Country:US
Practice Address - Phone:865-885-9193
Practice Address - Fax:865-882-9548
Is Sole Proprietor?:No
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist