Provider Demographics
NPI:1619247319
Name:SCOTT, CHAD BRIAN
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:BRIAN
Last Name:SCOTT
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 1:6 WHITE EAGLE CT
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-9742
Mailing Address - Country:US
Mailing Address - Phone:609-760-0801
Mailing Address - Fax:
Practice Address - Street 1:30 COOPER FOLLY RD
Practice Address - Street 2:
Practice Address - City:ATCO
Practice Address - State:NJ
Practice Address - Zip Code:08004-2649
Practice Address - Country:US
Practice Address - Phone:856-767-7222
Practice Address - Fax:856-767-5411
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000681002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer