Provider Demographics
NPI:1902966054
Name:PICKETT, SCOTT ALAN (LPTA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALAN
Last Name:PICKETT
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7172 MUSCADINE AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36618-3351
Mailing Address - Country:US
Mailing Address - Phone:251-583-0842
Mailing Address - Fax:
Practice Address - Street 1:67 E MIDTOWN PARK
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-4141
Practice Address - Country:US
Practice Address - Phone:251-476-1279
Practice Address - Fax:251-476-2882
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA1394225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant