Provider Demographics
NPI:1568491108
Name:KATHMANN, SCOTT ANTHONY (DPT, STC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ANTHONY
Last Name:KATHMANN
Suffix:
Gender:M
Credentials:DPT, STC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 OKATIE CENTER BLVD. S.
Mailing Address - Street 2:STE. 101
Mailing Address - City:OKATIE
Mailing Address - State:SC
Mailing Address - Zip Code:29909-7530
Mailing Address - Country:US
Mailing Address - Phone:843-705-9480
Mailing Address - Fax:843-705-9481
Practice Address - Street 1:4 OKATIE CENTER BLVD. S.
Practice Address - Street 2:STE. 101
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-7530
Practice Address - Country:US
Practice Address - Phone:843-705-9480
Practice Address - Fax:843-705-9481
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00656488OtherRAILROAD PROVIDER NUMBER
SC187190OtherMEDCOST PROVIDER NUMBER
SCP00656488OtherRAILROAD PROVIDER NUMBER
SCQ339907620Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
Q339908783Medicare PIN
SCQ339909053Medicare PIN