Provider Demographics
NPI:1275844409
Name:SCOTT HADLEY, LLC
Entity Type:Organization
Organization Name:SCOTT HADLEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:HADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:616-826-1576
Mailing Address - Street 1:756 COIT AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1508
Mailing Address - Country:US
Mailing Address - Phone:616-826-1576
Mailing Address - Fax:
Practice Address - Street 1:756 COIT AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1508
Practice Address - Country:US
Practice Address - Phone:616-826-1576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013534225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty