Provider Demographics
NPI:1316370125
Name:SCOTT, TRACY NICOLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:NICOLE
Last Name:SCOTT
Suffix:
Gender:F
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 1:65 MILLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-8888
Mailing Address - Country:US
Mailing Address - Phone:302-463-5214
Mailing Address - Fax:
Practice Address - Street 1:1 CENTURIAN DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2137
Practice Address - Country:US
Practice Address - Phone:302-633-5787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0003111225100000X
MD24662225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE338630ZBSXMedicare PIN
DEPTAN#G00716Medicare PIN