Provider Demographics
NPI:1750607719
Name:SCOTT, AMBROSIA DAVIDA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:AMBROSIA
Middle Name:DAVIDA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2867 POPLAR AVENUE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111
Mailing Address - Country:US
Mailing Address - Phone:901-458-5249
Mailing Address - Fax:901-458-9052
Practice Address - Street 1:2867 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-2023
Practice Address - Country:US
Practice Address - Phone:901-458-5249
Practice Address - Fax:901-458-9052
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1182087225100000X
TN8898225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist