Provider Demographics
NPI:1447317300
Name:DECKER, SCOTT HOWARD (PT)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:HOWARD
Last Name:DECKER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7050 E SUNRISE DR
Mailing Address - Street 2:APARTMENT 13106
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-0862
Mailing Address - Country:US
Mailing Address - Phone:847-962-7572
Mailing Address - Fax:
Practice Address - Street 1:2424 N WYATT DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6115
Practice Address - Country:US
Practice Address - Phone:520-784-6570
Practice Address - Fax:520-784-6574
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6986225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist