Individual
MR. STEWART BLAKE SCOGGIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
719 DETROIT ST, CHAMBERS MEMORIAL HOSPITAL, DANVILLE, AR 72833
(479) 495-6252
Mailing address
817 SANDSTONE CIR APT 4, RUSSELLVILLE, AR 72802-7104
(479) 675-6680
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA 2544
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
189733721
—
AR
Enumeration date
02/08/2012
Last updated
02/08/2012
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