Provider Demographics
NPI:1598733297
Name:FROST, SCOTT PAUL (MPT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:PAUL
Last Name:FROST
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 1:1159 N 1170 W
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:UT
Mailing Address - Zip Code:84015-8852
Mailing Address - Country:US
Mailing Address - Phone:336-404-2685
Mailing Address - Fax:
Practice Address - Street 1:4252 S BIRKHILL BLVD
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5715
Practice Address - Country:US
Practice Address - Phone:801-268-5423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10582225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
312571Medicare ID - Type Unspecified