Provider Demographics
NPI:1619704731
Name:SCOTTEN, JEREMY THOMAS (LMT)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:THOMAS
Last Name:SCOTTEN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10021 W WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-8327
Mailing Address - Country:US
Mailing Address - Phone:623-695-1581
Mailing Address - Fax:
Practice Address - Street 1:10021 W WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-8327
Practice Address - Country:US
Practice Address - Phone:623-695-1581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-14
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-29795225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist