Provider Demographics
NPI:1295812501
Name:HAVSY, SCOTT LESLIE (DO)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:LESLIE
Last Name:HAVSY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3716 PACIFIC AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-7836
Mailing Address - Country:US
Mailing Address - Phone:253-473-2663
Mailing Address - Fax:253-473-0545
Practice Address - Street 1:3716 PACIFIC AVE
Practice Address - Street 2:SUITE E
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-7836
Practice Address - Country:US
Practice Address - Phone:253-473-2663
Practice Address - Fax:253-473-0545
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA878208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation