Provider Demographics
NPI:1164620282
Name:PAWLICKI, SCOTT ALAN (PT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALAN
Last Name:PAWLICKI
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 1:3025 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-5053
Mailing Address - Country:US
Mailing Address - Phone:505-556-2120
Mailing Address - Fax:505-556-2190
Practice Address - Street 1:3025 TERRACE DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-5053
Practice Address - Country:US
Practice Address - Phone:505-556-2120
Practice Address - Fax:505-556-2190
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3267225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist