Healthcare Provider Details

I. General information

NPI: 1306504758
Provider Name (Legal Business Name): SCOTT THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 N 102ND WAY
MESA AZ
85207-4553
US

IV. Provider business mailing address

1307 N 102ND WAY
MESA AZ
85207-4553
US

V. Phone/Fax

Practice location:
  • Phone: 602-980-7090
  • Fax:
Mailing address:
  • Phone: 602-980-7090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID SCOTT MELLISH
Title or Position: ADMIN
Credential: PT
Phone: 602-980-7090