Provider Demographics
NPI:1770876534
Name:MORELAND, SCOTT G (DPT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:G
Last Name:MORELAND
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1014 MT. CARMEL PLACE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-6604
Mailing Address - Country:US
Mailing Address - Phone:620-235-1500
Mailing Address - Fax:620-235-1508
Practice Address - Street 1:10400 W 103RD ST
Practice Address - Street 2:SUITE 22
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66214-2640
Practice Address - Country:US
Practice Address - Phone:913-322-4000
Practice Address - Fax:913-322-4000
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1104431225100000X
MD237002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD12256594OtherCAQH