1568491108 NPI number — MR. SCOTT ANTHONY KATHMANN DPT, STC

Table of content: MR. SCOTT ANTHONY KATHMANN DPT, STC (NPI 1568491108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568491108 NPI number — MR. SCOTT ANTHONY KATHMANN DPT, STC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KATHMANN
Provider First Name:
SCOTT
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DPT, STC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568491108
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 OKATIE CENTER BLVD. S.
Provider Second Line Business Mailing Address:
STE. 101
Provider Business Mailing Address City Name:
OKATIE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29909-7530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-705-9480
Provider Business Mailing Address Fax Number:
843-705-9481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 OKATIE CENTER BLVD. S.
Provider Second Line Business Practice Location Address:
STE. 101
Provider Business Practice Location Address City Name:
OKATIE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29909-7530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-705-9480
Provider Business Practice Location Address Fax Number:
843-705-9481
Provider Enumeration Date:
07/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  5142 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00656488 . This is a "RAILROAD PROVIDER NUMBER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 187190 . This is a "MEDCOST PROVIDER NUMBER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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