Provider Demographics
NPI:1396044400
Name:SCOTT, JANIE CAMPBELL (LMT)
Entity Type:Individual
Prefix:MS
First Name:JANIE
Middle Name:CAMPBELL
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9114 58TH DRIVE EAST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202
Mailing Address - Country:US
Mailing Address - Phone:941-363-1793
Mailing Address - Fax:
Practice Address - Street 1:9114 58TH DRIVE EAST
Practice Address - Street 2:SUITE 112
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202
Practice Address - Country:US
Practice Address - Phone:941-363-1793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA62246225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist