Provider Demographics
NPI:1598246712
Name:SCOTTINO, AMY J (LMT, MTI)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:SCOTTINO
Suffix:
Gender:F
Credentials:LMT, MTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 WEST 15TH STREET
Mailing Address - Street 2:#310A
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075
Mailing Address - Country:US
Mailing Address - Phone:972-654-2341
Mailing Address - Fax:972-401-5939
Practice Address - Street 1:2121 W SPRING CREEK PKWY STE 111
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-4527
Practice Address - Country:US
Practice Address - Phone:972-741-0996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-25
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT119695225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty