Provider Demographics
NPI:1598788986
Name:PONTTI, SCOTT A
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:A
Last Name:PONTTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03216-0032
Mailing Address - Country:US
Mailing Address - Phone:603-735-6060
Mailing Address - Fax:877-521-6764
Practice Address - Street 1:1095 PROFILE RD
Practice Address - Street 2:
Practice Address - City:FRANCONIA
Practice Address - State:NH
Practice Address - Zip Code:03580-4938
Practice Address - Country:US
Practice Address - Phone:603-823-8600
Practice Address - Fax:603-823-8688
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021979225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02387653Medicaid
NY02387653Medicaid