Provider Demographics
NPI:1184498131
Name:SCOTT, PRECIOUS (LMT)
Entity type:Individual
Prefix:
First Name:PRECIOUS
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 SPRUCE DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS AFB
Mailing Address - State:ND
Mailing Address - Zip Code:58204-1859
Mailing Address - Country:US
Mailing Address - Phone:904-239-8215
Mailing Address - Fax:
Practice Address - Street 1:2021 SPRUCE DR UNIT A
Practice Address - Street 2:
Practice Address - City:GRAND FORKS AFB
Practice Address - State:ND
Practice Address - Zip Code:58204-1859
Practice Address - Country:US
Practice Address - Phone:904-239-8215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND22150225700000X
FLMA79375225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist