Provider Demographics
NPI:1114791381
Name:SCOTT, CORA G (DPT)
Entity Type:Individual
Prefix:
First Name:CORA
Middle Name:G
Last Name:SCOTT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-1309
Mailing Address - Country:US
Mailing Address - Phone:662-728-7218
Mailing Address - Fax:662-728-7228
Practice Address - Street 1:809 N 2ND ST
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-1309
Practice Address - Country:US
Practice Address - Phone:662-728-7218
Practice Address - Fax:662-728-7228
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT7654225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist