Provider Demographics
NPI:1144353624
Name:SCOTT, KRISTAL J (PT MPT)
Entity type:Individual
Prefix:MRS
First Name:KRISTAL
Middle Name:J
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PT MPT
Other - Prefix:MISS
Other - First Name:KRISTAL
Other - Middle Name:J
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT MPT
Mailing Address - Street 1:2940 E BANNER GATEWAY DR
Mailing Address - Street 2:SUITE 425
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2168
Mailing Address - Country:US
Mailing Address - Phone:480-813-7900
Mailing Address - Fax:
Practice Address - Street 1:2940 E BANNER GATEWAY DR
Practice Address - Street 2:SUITE 425
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2168
Practice Address - Country:US
Practice Address - Phone:480-813-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist