Provider Demographics
NPI:1619942364
Name:BRUCE, SCOTT LOUIS (EDD, ATC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:LOUIS
Last Name:BRUCE
Suffix:
Gender:M
Credentials:EDD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 NEW POND HILL DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-8026
Mailing Address - Country:US
Mailing Address - Phone:423-240-7180
Mailing Address - Fax:
Practice Address - Street 1:104 N. CARAWAY RD
Practice Address - Street 2:SMITH 301
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401
Practice Address - Country:US
Practice Address - Phone:870-972-3822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART000201A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer