Provider Demographics
NPI:1629333026
Name:ITZ, SCOTT EMERSON (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:EMERSON
Last Name:ITZ
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-6139
Mailing Address - Country:US
Mailing Address - Phone:830-456-2328
Mailing Address - Fax:
Practice Address - Street 1:3017 TANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-6139
Practice Address - Country:US
Practice Address - Phone:830-456-2328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT41202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer