Provider Demographics
NPI:1598006819
Name:TRAHAN, SCOT A (LMT, MMP)
Entity Type:Individual
Prefix:MR
First Name:SCOT
Middle Name:A
Last Name:TRAHAN
Suffix:
Gender:M
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 ROUND ROCK WEST DR
Mailing Address - Street 2:SUITE 601
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5011
Mailing Address - Country:US
Mailing Address - Phone:512-363-5946
Mailing Address - Fax:512-377-1102
Practice Address - Street 1:595 ROUND ROCK WEST DR
Practice Address - Street 2:SUITE 601
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5011
Practice Address - Country:US
Practice Address - Phone:512-363-5946
Practice Address - Fax:512-377-1102
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106199225400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist