Provider Demographics
NPI:1629004536
Name:SCOFIELD, JACQUELINE R (PT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:R
Last Name:SCOFIELD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:M
Other - Last Name:ROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1025 BULLARD CT STE 105
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6874
Mailing Address - Country:US
Mailing Address - Phone:919-875-1932
Mailing Address - Fax:919-875-1933
Practice Address - Street 1:1025 BULLARD CT STE 105
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6874
Practice Address - Country:US
Practice Address - Phone:919-875-1932
Practice Address - Fax:919-875-1933
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002230225100000X
NCP8339225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist