Provider Demographics
NPI:1508143892
Name:SCOTT, SHEREE LAVETTE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:SHEREE
Middle Name:LAVETTE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 LOWER FAYETTEVILLE RD STE 2000
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-6506
Mailing Address - Country:US
Mailing Address - Phone:770-251-7284
Mailing Address - Fax:
Practice Address - Street 1:1111 LOWER FAYETTEVILLE RD STE 2000
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-6506
Practice Address - Country:US
Practice Address - Phone:770-251-7284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA40455225700000X
FLPTA22148225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist