Provider Demographics
NPI:1205017159
Name:HADLEY, SCOTT DOUGLAS (PHD, DPT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:DOUGLAS
Last Name:HADLEY
Suffix:
Gender:M
Credentials:PHD, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 MONROE AVE NW
Mailing Address - Street 2:STE. 5201
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1055
Mailing Address - Country:US
Mailing Address - Phone:616-401-2785
Mailing Address - Fax:616-328-6585
Practice Address - Street 1:1140 MONROE AVE NW
Practice Address - Street 2:STE. 5201
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1055
Practice Address - Country:US
Practice Address - Phone:616-401-2785
Practice Address - Fax:616-328-6585
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013534225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist