Provider Demographics
NPI:1265446736
Name:SCOTT, PENELOPE CONSTANCE (LMT)
Entity Type:Individual
Prefix:MS
First Name:PENELOPE
Middle Name:CONSTANCE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3770 CURTIS BLVD
Mailing Address - Street 2:SUITE 710
Mailing Address - City:PORT ST JOHN
Mailing Address - State:FL
Mailing Address - Zip Code:32927-3965
Mailing Address - Country:US
Mailing Address - Phone:321-631-3233
Mailing Address - Fax:
Practice Address - Street 1:3770 CURTIS BLVD
Practice Address - Street 2:SUITE 710
Practice Address - City:PORT ST JOHN
Practice Address - State:FL
Practice Address - Zip Code:32927-3965
Practice Address - Country:US
Practice Address - Phone:321-631-3233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA43820225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist