Provider Demographics
NPI:1487850434
Name:SCOTT, KRISTIN M (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:M
Last Name:SCOTT
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 1:12970 W SANCTUARY CT
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-1139
Mailing Address - Country:US
Mailing Address - Phone:847-323-6129
Mailing Address - Fax:
Practice Address - Street 1:12970 W SANCTUARY CT
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-1139
Practice Address - Country:US
Practice Address - Phone:847-323-6129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012706174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist