Provider Demographics
NPI:1245663715
Name:MCNULTY, SCOTT RICHARD (DPT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:RICHARD
Last Name:MCNULTY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:25241 ELEMENTARY WAY
Mailing Address - Street 2:STE 200
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-7883
Mailing Address - Country:US
Mailing Address - Phone:239-947-4184
Mailing Address - Fax:239-947-4171
Practice Address - Street 1:12250 TAMIAMI TRL E
Practice Address - Street 2:STE 102
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-8108
Practice Address - Country:US
Practice Address - Phone:239-417-0027
Practice Address - Fax:239-417-0041
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT28332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist