Provider Demographics
NPI:1255638714
Name:SCOTT, SHYLA D (PT, DPT)
Entity type:Individual
Prefix:
First Name:SHYLA
Middle Name:D
Last Name:SCOTT
Suffix:
Gender:F
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 1:1578 VENICE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-5739
Mailing Address - Country:US
Mailing Address - Phone:850-862-1999
Mailing Address - Fax:850-862-1999
Practice Address - Street 1:1578 VENICE AVE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-5739
Practice Address - Country:US
Practice Address - Phone:850-862-1999
Practice Address - Fax:850-862-1999
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22292225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist