Healthcare Provider Details

I. General information

NPI: 1245782093
Provider Name (Legal Business Name): SCOTT NELSON NEWBERRY PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 SOUTH CHARLES STREET SUITE 201
BALTIMORE MD
21201
US

IV. Provider business mailing address

575 SOUTH CHARLES STREET SUITE 201
BALTIMORE MD
21201
US

V. Phone/Fax

Practice location:
  • Phone: 443-524-0442
  • Fax: 410-752-8430
Mailing address:
  • Phone: 443-524-0442
  • Fax: 410-752-8430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number26965
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: