Provider Demographics
NPI:1265668909
Name:ELDRIDGE, SCOTT MICHAEL (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:MICHAEL
Last Name:ELDRIDGE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 203968
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78720-3968
Mailing Address - Country:US
Mailing Address - Phone:512-467-1100
Mailing Address - Fax:512-467-1101
Practice Address - Street 1:911 W ANDERSON LN
Practice Address - Street 2:SUITE 103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-1501
Practice Address - Country:US
Practice Address - Phone:512-467-1100
Practice Address - Fax:512-467-1101
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1216921225100000X
LA07578225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist