Provider Demographics
NPI:1417358912
Name:EWING, SCARLET MAHINA (DPT)
Entity Type:Individual
Prefix:MRS
First Name:SCARLET
Middle Name:MAHINA
Last Name:EWING
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 1:150 OSIGIAN BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088
Mailing Address - Country:US
Mailing Address - Phone:478-333-3075
Mailing Address - Fax:478-333-3484
Practice Address - Street 1:6010 LAKESIDE COMMONS DRIVE
Practice Address - Street 2:SUITE D
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210
Practice Address - Country:US
Practice Address - Phone:478-254-6880
Practice Address - Fax:478-254-6883
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011682225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist