Provider Demographics
NPI:1942247515
Name:COON, SCOTT B (PT MTC CFMT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:B
Last Name:COON
Suffix:
Gender:M
Credentials:PT MTC CFMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10207 SOUTH DOLFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3607
Mailing Address - Country:US
Mailing Address - Phone:410-902-5997
Mailing Address - Fax:410-902-5776
Practice Address - Street 1:10207 SOUTH DOLFIELD ROAD
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3607
Practice Address - Country:US
Practice Address - Phone:410-902-5997
Practice Address - Fax:410-902-5776
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16517225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
42577842OtherCAREFIRST BCBS
N1830001OtherCAREFIRST BCBS
4257784ZOtherCAREFIRST BCBS
4257784ZOtherCAREFIRST BCBS
N1830001OtherCAREFIRST BCBS