Provider Demographics
NPI:1265704019
Name:SCOTT, DARIA (PTA)
Entity type:Individual
Prefix:
First Name:DARIA
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:DARIA
Other - Middle Name:
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:2401 OAKBROOK DRIVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628
Mailing Address - Country:US
Mailing Address - Phone:574-904-5155
Mailing Address - Fax:
Practice Address - Street 1:2401 OAKBROOK DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-3495
Practice Address - Country:US
Practice Address - Phone:574-904-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002183A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant