Provider Demographics
NPI:1356639686
Name:SPOTT, DEANNA MARIE (DPT)
Entity Type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:MARIE
Last Name:SPOTT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SIMPSON
Mailing Address - State:PA
Mailing Address - Zip Code:18407-1218
Mailing Address - Country:US
Mailing Address - Phone:570-335-6650
Mailing Address - Fax:
Practice Address - Street 1:10 HART PL
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-1593
Practice Address - Country:US
Practice Address - Phone:570-282-5264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATPT021105225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist