Provider Demographics
NPI:1659919736
Name:DOUGLAS, SCOTT PATRICK (DPT)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:PATRICK
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 HERRINGTOWN RD
Mailing Address - Street 2:
Mailing Address - City:SHINGLEHOUSE
Mailing Address - State:PA
Mailing Address - Zip Code:16748-4413
Mailing Address - Country:US
Mailing Address - Phone:585-689-9213
Mailing Address - Fax:
Practice Address - Street 1:2400 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1297
Practice Address - Country:US
Practice Address - Phone:800-813-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
OR63651225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist