Healthcare Provider Details

I. General information

NPI: 1972093649
Provider Name (Legal Business Name): SCOTT WILLIAM SYVERSON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 01/19/2024
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 17TH AVE E
ALEXANDRIA MN
56308-5273
US

IV. Provider business mailing address

8241 ROLLING ACRES CIR NW
ALEXANDRIA MN
56308-9713
US

V. Phone/Fax

Practice location:
  • Phone: 320-762-6079
  • Fax: 320-762-6123
Mailing address:
  • Phone: 218-639-2141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4598
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: