Provider Demographics
NPI:1326190760
Name:MALOTT, SCOTT A (PT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:MALOTT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-1951
Mailing Address - Country:US
Mailing Address - Phone:765-348-4197
Mailing Address - Fax:765-348-9627
Practice Address - Street 1:1709 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-1951
Practice Address - Country:US
Practice Address - Phone:765-348-4197
Practice Address - Fax:765-348-9627
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05006441A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist