Provider Demographics
NPI:1174806624
Name:SCOTT, MATTHEW ARCHIBALD (DPT, ATC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ARCHIBALD
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 W. 400 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057
Mailing Address - Country:US
Mailing Address - Phone:801-221-9071
Mailing Address - Fax:801-221-9071
Practice Address - Street 1:147 W 400 N
Practice Address - Street 2:SUITE C
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-4658
Practice Address - Country:US
Practice Address - Phone:801-221-9060
Practice Address - Fax:801-294-6917
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7960606-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000075336Medicare UPIN