Healthcare Provider Details

I. General information

NPI: 1720005655
Provider Name (Legal Business Name): SCOTT DAVID WAUGH PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 BEACON ST
BROOKLINE MA
02446-5587
US

IV. Provider business mailing address

62 DAMON RD
HANOVER MA
02339-1131
US

V. Phone/Fax

Practice location:
  • Phone: 617-232-6633
  • Fax: 617-232-6832
Mailing address:
  • Phone: 787-871-6659
  • Fax: 617-232-6832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8158
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8158
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerMA PT LISENCE NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: