Provider Demographics
NPI:1811042658
Name:SCRUGGS, D MARTIN II (ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:D
Middle Name:MARTIN
Last Name:SCRUGGS
Suffix:II
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 BOULDINCREST AVE
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-6882
Mailing Address - Country:US
Mailing Address - Phone:901-861-6434
Mailing Address - Fax:
Practice Address - Street 1:5900 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2104
Practice Address - Country:US
Practice Address - Phone:901-261-4960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer