Provider Demographics
NPI:1902245541
Name:KINGSBURY, SCOTT D (ORTHOPEDIC THERAPIST)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:D
Last Name:KINGSBURY
Suffix:
Gender:M
Credentials:ORTHOPEDIC THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 CROTON RD
Mailing Address - Street 2:P.O. BOX 360654
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-3164
Mailing Address - Country:US
Mailing Address - Phone:321-693-3879
Mailing Address - Fax:
Practice Address - Street 1:1300 CROTON RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3164
Practice Address - Country:US
Practice Address - Phone:321-693-3879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA30910173C00000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
No174H00000XOther Service ProvidersHealth Educator