Provider Demographics
NPI:1386639987
Name:MYRICK, SCOTT A (ATC, CSCS, HFI)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:A
Last Name:MYRICK
Suffix:
Gender:M
Credentials:ATC, CSCS, HFI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 AVONWOOD RD
Mailing Address - Street 2:APT 204
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-2049
Mailing Address - Country:US
Mailing Address - Phone:860-906-7691
Mailing Address - Fax:
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:MARB FIRST FLOOR
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-0001
Practice Address - Country:US
Practice Address - Phone:860-679-3233
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer