Provider Demographics
NPI:1801036504
Name:SCROGGIN, JON STEVEN (PT)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:STEVEN
Last Name:SCROGGIN
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 1:1101 HORSEBARN RD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8237
Mailing Address - Country:US
Mailing Address - Phone:479-271-4170
Mailing Address - Fax:
Practice Address - Street 1:1101 HORSEBARN RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8237
Practice Address - Country:US
Practice Address - Phone:479-271-4170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 2516225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist