Provider Demographics
NPI:1942852819
Name:SCARBOROUGH, TY (PT)
Entity Type:Individual
Prefix:
First Name:TY
Middle Name:
Last Name:SCARBOROUGH
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 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-8930
Mailing Address - Fax:
Practice Address - Street 1:712 N ELLINGTON PKWY STE 6
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-2454
Practice Address - Country:US
Practice Address - Phone:931-359-1913
Practice Address - Fax:931-359-1932
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12519225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist