Provider Demographics
NPI:1750627725
Name:ENTSMINGER, SCOTT A (PT,DPT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:ENTSMINGER
Suffix:
Gender:M
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 1:4300 S BEACH PKWY APT 1311
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-8175
Mailing Address - Country:US
Mailing Address - Phone:904-996-6922
Mailing Address - Fax:907-996-6923
Practice Address - Street 1:13947 BEACH BLVD STE 109
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-1201
Practice Address - Country:US
Practice Address - Phone:904-996-6922
Practice Address - Fax:904-996-6923
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27630174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist