Provider Demographics
NPI:1619182623
Name:RENDELL, SCOTT A (PT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:RENDELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8995 E 34TH PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-3425
Mailing Address - Country:US
Mailing Address - Phone:716-310-8087
Mailing Address - Fax:
Practice Address - Street 1:14101 E EVANS AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1451
Practice Address - Country:US
Practice Address - Phone:720-222-4261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-12
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20909225100000X
NY024655225100000X
NC9185225100000X
CO10306225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist