Provider Demographics
NPI:1659436236
Name:SALL, SCOTT A (PT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:SALL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3080 WHISPERING PINES CIR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35226-3428
Mailing Address - Country:US
Mailing Address - Phone:205-823-4218
Mailing Address - Fax:
Practice Address - Street 1:2870 OLD ROCKY RIDGE RD
Practice Address - Street 2:SUITE 115
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-2927
Practice Address - Country:US
Practice Address - Phone:205-822-8335
Practice Address - Fax:205-822-8337
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH2986225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51523555OtherBLUE CROSS BLUE SHIELD
ALVIVA HEALTHOther050571189
AL0007753741OtherAETNA
AL050571189 35243 A001OtherTRICARE
AL529925400Medicaid
AL050571189 35243 A001OtherTRICARE