Provider Demographics
NPI:1922856814
Name:LEITHOLF, SCOTT DANIEL (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DANIEL
Last Name:LEITHOLF
Suffix:
Gender:M
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 1:3045 KATE BOND RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4004
Mailing Address - Country:US
Mailing Address - Phone:901-937-3200
Mailing Address - Fax:901-725-8346
Practice Address - Street 1:3045 KATE BOND RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4004
Practice Address - Country:US
Practice Address - Phone:901-937-3200
Practice Address - Fax:901-725-8346
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305216496225100000X
TN16380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist