Healthcare Provider Details

I. General information

NPI: 1699738963
Provider Name (Legal Business Name): SCOTT R PLUSKIS ATC/L
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3817 NW 62ND ST
COCONUT CREEK FL
33073-2146
US

IV. Provider business mailing address

3817 NW 62ND ST
COCONUT CREEK FL
33073-2146
US

V. Phone/Fax

Practice location:
  • Phone: 954-478-0302
  • Fax: 561-488-1064
Mailing address:
  • Phone: 954-478-0302
  • Fax: 561-488-1064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL671
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberBMO 66516
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: