Provider Demographics
NPI:1144393042
Name:SEARS, SCOTT WALTER (PT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:WALTER
Last Name:SEARS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CORNERSTONE DR
Mailing Address - Street 2:STE 315
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495
Mailing Address - Country:US
Mailing Address - Phone:802-878-3600
Mailing Address - Fax:802-879-3041
Practice Address - Street 1:300 CORNERSTONE DR
Practice Address - Street 2:STE 315
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495
Practice Address - Country:US
Practice Address - Phone:802-878-3600
Practice Address - Fax:802-879-3041
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400002381225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN1958Medicaid
VT4591OtherBCBS
VTVN1958Medicare ID - Type Unspecified