Provider Demographics
NPI:1720040348
Name:SCOTT, TERRA RAE (MSPT)
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:RAE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6970 S HOLLY CIRCLE
Mailing Address - Street 2:#200
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112
Mailing Address - Country:US
Mailing Address - Phone:303-437-4364
Mailing Address - Fax:303-223-3462
Practice Address - Street 1:6970 S HOLLY CIRCLE
Practice Address - Street 2:#200
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112
Practice Address - Country:US
Practice Address - Phone:303-437-4364
Practice Address - Fax:303-223-3462
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6860225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO50370570Medicaid
CO50370570Medicaid