Provider Demographics
NPI:1790757060
Name:WEIL, SCOTT W (ATC PTA)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:W
Last Name:WEIL
Suffix:
Gender:M
Credentials:ATC PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12652 THICKET RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-1326
Mailing Address - Country:US
Mailing Address - Phone:904-268-6714
Mailing Address - Fax:
Practice Address - Street 1:10601 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8203
Practice Address - Country:US
Practice Address - Phone:904-260-4977
Practice Address - Fax:904-260-4976
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA1272225200000X
FLAL4112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer