Provider Demographics
NPI:1215578919
Name:SCOTT, DELTA BRIONNE
Entity Type:Individual
Prefix:
First Name:DELTA
Middle Name:BRIONNE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22315 LA SEINE ST APT 222
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4042
Mailing Address - Country:US
Mailing Address - Phone:248-508-7071
Mailing Address - Fax:
Practice Address - Street 1:25750 LAHSER RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-5809
Practice Address - Country:US
Practice Address - Phone:248-415-2500
Practice Address - Fax:248-415-2510
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant