Provider Demographics
NPI:1396868840
Name:RUSIN, SCOTT THOMAS (MPT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:THOMAS
Last Name:RUSIN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CALUSA BLVD
Mailing Address - Street 2:# 300
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-5753
Mailing Address - Country:US
Mailing Address - Phone:803-414-9880
Mailing Address - Fax:850-460-7987
Practice Address - Street 1:200 CALUSA BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541
Practice Address - Country:US
Practice Address - Phone:850-460-2024
Practice Address - Fax:850-460-7987
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23308225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6923846OtherCIGNA
FL735439OtherOPTUM HEALTH/UNITEDHEALTHCARE INDIVIDUAL
FLY906XOtherBCBSFL GRP #
FLIF717ZMedicare PIN