MEDICARE: SHYLA D SCOTT PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT22292	FL

General Provider Information

NPI Number	:	1255638714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHYLA D SCOTT PT, DPT

Provider Business Mailing Address
First Line	:	1578 VENICE AVE
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-5739
Country	:	US
Telephone Number	:	850-862-1999
Fax Number	:	850-862-1999

Provider Business Practice Location Address
First Line	:	1578 VENICE AVE
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-5739
Country	:	US
Telephone Number	:	850-862-1999
Fax Number	:	850-862-1999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2011
Last Update Date	:	02/18/2011

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