Provider Demographics
NPI:1265447924
Name:TENNIS, SCOTT DANIEL (PT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:DANIEL
Last Name:TENNIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:711 W 40TH ST STE 352
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2100
Practice Address - Country:US
Practice Address - Phone:410-243-5399
Practice Address - Fax:410-243-5366
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL28174225100000X
MD19706225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist