Provider Demographics
NPI:1407329907
Name:MCQUEEN, SCOTT B (PTA)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:B
Last Name:MCQUEEN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:MR
Other - First Name:SCOTT
Other - Middle Name:B
Other - Last Name:MCQUEEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:1902 BRIDGET DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129
Mailing Address - Country:US
Mailing Address - Phone:615-584-9215
Mailing Address - Fax:
Practice Address - Street 1:345 COMPTON RD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-1352
Practice Address - Country:US
Practice Address - Phone:615-895-8850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2137225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant