Provider Demographics
NPI:1902968761
Name:SCOTT, KEITH DAVID (PT)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:DAVID
Last Name:SCOTT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7727 LEEDS MANOR RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:VA
Mailing Address - Zip Code:20115-2657
Mailing Address - Country:US
Mailing Address - Phone:703-934-9411
Mailing Address - Fax:703-934-9497
Practice Address - Street 1:10525 WEST DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4230
Practice Address - Country:US
Practice Address - Phone:703-934-9411
Practice Address - Fax:703-934-9497
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23050025662251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG02052OtherMEDICARE GROUP PIN
DCG02052F01Medicare PIN
DCG02052OtherMEDICARE GROUP PIN