=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104209667
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLY SCOTT DPT, DSC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2015
-----------------------------------------------------
Last Update Date | 07/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 WASHINGTON RD
-----------------------------------------------------
City | WEST POINT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10996-1109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-595-7263
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1060 GAFFNEY RD STOP 7400
-----------------------------------------------------
City | FORT WAINWRIGHT
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99703-5007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251S0007X
-----------------------------------------------------
Taxonomy Name | Sports Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------