Provider Demographics
NPI:1023655016
Name:KONINGSWOOD, SCOTT JOSEPH (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:JOSEPH
Last Name:KONINGSWOOD
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-3331
Mailing Address - Country:US
Mailing Address - Phone:973-513-2120
Mailing Address - Fax:
Practice Address - Street 1:251 ROCK RD STE 2C
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-1797
Practice Address - Country:US
Practice Address - Phone:201-445-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01907700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist