Provider Demographics
NPI:1568798692
Name:DEWIG, SCOTT THOMAS (PT, MPT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:THOMAS
Last Name:DEWIG
Suffix:
Gender:M
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:3947 GULF SHORES PKWY
Practice Address - Street 2:STE 260
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542-2735
Practice Address - Country:US
Practice Address - Phone:251-943-0803
Practice Address - Fax:251-943-4403
Is Sole Proprietor?:No
Enumeration Date:2009-10-24
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.017260225100000X
ALPTH8155225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist