Provider Demographics
NPI:1962511071
Name:PAUW, SCOTT (PT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:PAUW
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 1:144 EVERETT PARK
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-5822
Mailing Address - Country:US
Mailing Address - Phone:317-340-8442
Mailing Address - Fax:
Practice Address - Street 1:75 NEWPORT RD UNIT 3
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257-5467
Practice Address - Country:US
Practice Address - Phone:603-526-2781
Practice Address - Fax:603-526-2618
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3140225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000176003OtherBCBS
IN1977060OtherFIRST HEALTH