Provider Demographics
NPI:1558625673
Name:SCOTT, RYAN J (LMP)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:J
Last Name:SCOTT
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 41ST ST E
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98371-2599
Mailing Address - Country:US
Mailing Address - Phone:253-202-7567
Mailing Address - Fax:253-539-5666
Practice Address - Street 1:10625 PACIFIC AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-6065
Practice Address - Country:US
Practice Address - Phone:253-202-7567
Practice Address - Fax:253-539-5666
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60271081172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist