Provider Demographics
NPI:1770798530
Name:PORTER, SCOTT STUART (PT)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:STUART
Last Name:PORTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3657 CORTEZ RD W STE 110
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3171
Mailing Address - Country:US
Mailing Address - Phone:941-361-9020
Mailing Address - Fax:941-217-4038
Practice Address - Street 1:8588 POTTER PARK DR STE 201
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-5471
Practice Address - Country:US
Practice Address - Phone:941-361-9020
Practice Address - Fax:941-217-4038
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT10298225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4496768OtherAETNA
FLQ08OtherBCBS OF FL
FLQ08OtherBCBS OF FL