Healthcare Provider Details

I. General information

NPI: 1124479522
Provider Name (Legal Business Name): SCOOTER PHILLIPS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

2300 W MORTON ST STE 114
DENISON TX
75020-1671
US

IV. Provider business mailing address

2300 W MORTON ST STE 114
DENISON TX
75020-1671
US

V. Phone/Fax

Practice location:
  • Phone: 903-462-4085
  • Fax: 903-465-5533
Mailing address:
  • Phone: 903-462-4085
  • Fax: 903-465-5533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHARLES BLAKE SMITH
Title or Position: ADMINISTRATOR / DIRECTOR
Credential:
Phone: 903-462-4085