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General NPI Number Information
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NPI Number | 1356590913
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Entity Type | Individual
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Provider Name | JASON ALEXANDER SCOTT D.P.T.
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Gender | Male
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Dates
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Enumeration Date | 09/18/2008
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Last Update Date | 09/18/2008
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Provider Practice Location Address
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Address Line | 2016 S MAIN ST
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City | MARYVILLE
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State | MO
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Zip | 64468-2655
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Country | US
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Telephone | 660-853-9702
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Fax |
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Provider Business Mailing Address
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Address Line | 24713 KATYDID RD
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City | MARYVILLE
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State | MO
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Zip | 64468-8360
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Country | US
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Telephone | 660-853-9702
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.015344
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2006033826
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11-03690
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License Number State | KS
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