Provider Demographics
NPI:1467995431
Name:CARLSON, SCOTT (DPT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:CARLSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15609 RONALD W REAGAN BLVD BLDG A130
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-1472
Mailing Address - Country:US
Mailing Address - Phone:512-986-4468
Mailing Address - Fax:512-986-7076
Practice Address - Street 1:15609 RONALD W REAGAN BLVD BLDG A130
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-1472
Practice Address - Country:US
Practice Address - Phone:512-986-4468
Practice Address - Fax:512-986-7076
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-23
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1283496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist