Provider Demographics
NPI:1659519015
Name:GUTSHALL, SCOTT (PT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:GUTSHALL
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 1:34 HILLSIDE MANOR CT
Mailing Address - Street 2:
Mailing Address - City:ST. PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-4144
Mailing Address - Country:US
Mailing Address - Phone:314-922-6844
Mailing Address - Fax:636-294-9500
Practice Address - Street 1:34 HILLSIDE MANOR CT
Practice Address - Street 2:
Practice Address - City:ST. PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-4144
Practice Address - Country:US
Practice Address - Phone:314-922-6844
Practice Address - Fax:636-294-9500
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004028835225100000X
IL070.012079225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist