Provider Demographics
NPI:1710945233
Name:MAW, SCOTT B (MSPT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:B
Last Name:MAW
Suffix:
Gender:M
Credentials:MSPT
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Mailing Address - Street 1:4040 ORCHARD ST W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6606
Mailing Address - Country:US
Mailing Address - Phone:253-564-1560
Mailing Address - Fax:253-564-4449
Practice Address - Street 1:463 TREMONT ST W
Practice Address - Street 2:SUITE 103
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3743
Practice Address - Country:US
Practice Address - Phone:360-876-7129
Practice Address - Fax:360-876-2914
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-06-20
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Provider Licenses
StateLicense IDTaxonomies
WAPT00008999225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8360562Medicaid
WAAB38270Medicare ID - Type Unspecified
WAAB38278Medicare ID - Type Unspecified