Provider Demographics
NPI:1497842249
Name:MCDONOUGH, SCOTT W (PT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:W
Last Name:MCDONOUGH
Suffix:
Gender:M
Credentials:PT
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Other - Credentials:
Mailing Address - Street 1:2209 GENESEE STREET
Mailing Address - Street 2:BUSINESS OFFICE ROOM 310
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5930
Mailing Address - Country:US
Mailing Address - Phone:315-801-3282
Mailing Address - Fax:315-801-8391
Practice Address - Street 1:1676 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5416
Practice Address - Country:US
Practice Address - Phone:315-624-5400
Practice Address - Fax:315-624-5395
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2018-09-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY013228-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400045694Medicare PIN