MEDICARE: SCOTT ETHERIDGE 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	070.029326	IL

General Provider Information

NPI Number	:	1538048277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT ETHERIDGE PT, DPT

Provider Business Mailing Address
First Line	:	5732 WALNUT AVE APT 2A
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60516-1097
Country	:	US
Telephone Number	:	630-453-9917
Fax Number	:

Provider Business Practice Location Address
First Line	:	1026 OGDEN AVE STE 1026
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-2812
Country	:	US
Telephone Number	:	630-856-7600
Fax Number	:

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

Provider Enumeration Date	:	08/28/2025
Last Update Date	:	08/28/2025

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Directions to “ SCOTT ETHERIDGE PT, DPT” Practice Location

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