Provider Demographics
NPI:1982754917
Name:SCOTT, KRISTA KATHLEEN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:KATHLEEN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5206
Mailing Address - Country:US
Mailing Address - Phone:970-247-5411
Mailing Address - Fax:
Practice Address - Street 1:201 E 12TH ST
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5206
Practice Address - Country:US
Practice Address - Phone:970-247-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012233225100000X
COPTL.0014547225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP01368856Medicare PIN
MIN69750049Medicare PIN