Provider Demographics
NPI:1922480813
Name:SCOTT, GIDGET
Entity Type:Individual
Prefix:
First Name:GIDGET
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ATWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:67730-1535
Mailing Address - Country:US
Mailing Address - Phone:888-873-4221
Mailing Address - Fax:
Practice Address - Street 1:650 LAKE RD
Practice Address - Street 2:
Practice Address - City:ATWOOD
Practice Address - State:KS
Practice Address - Zip Code:67730-1535
Practice Address - Country:US
Practice Address - Phone:888-873-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-00293225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant