Provider Demographics
NPI:1477623601
Name:SMITH, SCOTT (PT)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 MOKUAHI ST
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8963
Mailing Address - Country:US
Mailing Address - Phone:808-398-2552
Mailing Address - Fax:
Practice Address - Street 1:66-150 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-1440
Practice Address - Country:US
Practice Address - Phone:808-799-7137
Practice Address - Fax:808-356-1084
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4674225100000X
CAPT27901225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist