MEDICARE: KRISTIN THERESA SCOTLAND PT

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	23284	FL
2	225100000X	Physical Therapist	13258	NC
3	225100000X	Physical Therapist	6383	SC

General Provider Information

NPI Number	:	1992072599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN THERESA SCOTLAND PT

Provider Business Mailing Address
First Line	:	16511 FOREST LAKE DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-1204
Country	:	US
Telephone Number	:	813-748-2993
Fax Number	:

Provider Business Practice Location Address
First Line	:	16511 FOREST LAKE DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-1204
Country	:	US
Telephone Number	:	813-748-2993
Fax Number	:

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

Provider Enumeration Date	:	11/27/2011
Last Update Date	:	11/27/2011

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