Provider Demographics
NPI:1861258493
Name:SCOTT, CHRISTAL S (PTA)
Entity type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:S
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CHRISTAL
Other - Middle Name:SHEREE
Other - Last Name:SMILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:1715 GODELLO DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-0264
Mailing Address - Country:US
Mailing Address - Phone:770-548-4878
Mailing Address - Fax:
Practice Address - Street 1:720 E RALPH HALL PKWY
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6883
Practice Address - Country:US
Practice Address - Phone:770-548-4878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011027294225200000X
TXCP022405A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant