Provider Demographics
NPI:1639807654
Name:SCOTT, NYISHA (PTA)
Entity Type:Individual
Prefix:
First Name:NYISHA
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21600 NOVI RD STE 400
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-5605
Mailing Address - Country:US
Mailing Address - Phone:248-679-5396
Mailing Address - Fax:248-679-5397
Practice Address - Street 1:21600 NOVI RD STE 400
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-5605
Practice Address - Country:US
Practice Address - Phone:248-679-5396
Practice Address - Fax:248-679-5397
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502008201225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant