Provider Demographics
NPI:1750791893
Name:BERNSTEIN, SCOTT (PTA)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11503 SUMMER HAVEN BLVD N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-2545
Mailing Address - Country:US
Mailing Address - Phone:954-290-7221
Mailing Address - Fax:
Practice Address - Street 1:11503 SUMMER HAVEN BLVD N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-2545
Practice Address - Country:US
Practice Address - Phone:954-290-7221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA24821225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant