Provider Demographics
NPI:1568484475
Name:PHISTER, SCOTT ELVIN (MPT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ELVIN
Last Name:PHISTER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 WEST SUNSET DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501
Mailing Address - Country:US
Mailing Address - Phone:307-856-7021
Mailing Address - Fax:307-856-5546
Practice Address - Street 1:2002 WEST SUNSET DR
Practice Address - Street 2:SUITE 1
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501
Practice Address - Country:US
Practice Address - Phone:307-856-7021
Practice Address - Fax:307-856-5546
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT469225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY307314OtherBLUE CROSS BLUE SHIELF
WY307314OtherBLUE CROSS BLUE SHIELF
WYW307314Medicare PIN