Provider Demographics
NPI:1598853582
Name:WALLENTINE, SCOTT WINTERS (DPT)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:WINTERS
Last Name:WALLENTINE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:901 S NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65897-0027
Mailing Address - Country:US
Mailing Address - Phone:417-836-3070
Mailing Address - Fax:417-836-3032
Practice Address - Street 1:606 E CHERRY ST
Practice Address - Street 2:ROOM 100
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65806-3401
Practice Address - Country:US
Practice Address - Phone:417-836-3070
Practice Address - Fax:417-836-3032
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO1999135665225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist