Individual
MR. CARL BRENT SCOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2021 MAHANEY AVE., STE. 6, NORTHEASTERN PHYSICAL REHAB, TAHLEQUAH, OK 74464
(918) 458-5115
(918) 458-5119
Mailing address
1212 PINEHURST CT., FORT GIBSON, OK 74434
(918) 478-8249
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1994
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100834890A
—
OK
01
—
175254900
DEPT OF LABOR
OK
01
—
650020254
RR MEDICARE
OK
01
—
A002
TRICARE
OK
Enumeration date
06/13/2006
Last updated
12/06/2013
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