Provider Demographics
NPI:1649896440
Name:WHITED, SCOTT ALLEN
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALLEN
Last Name:WHITED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:THURSTON
Mailing Address - State:OH
Mailing Address - Zip Code:43157-0052
Mailing Address - Country:US
Mailing Address - Phone:614-725-9772
Mailing Address - Fax:
Practice Address - Street 1:14176 NATIONAL RD SW
Practice Address - Street 2:
Practice Address - City:ETNA
Practice Address - State:OH
Practice Address - Zip Code:43068-3363
Practice Address - Country:US
Practice Address - Phone:740-927-6782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH043282081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine