Provider Demographics
NPI:1447535182
Name:DELANGE, SCOTT (DPT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:DELANGE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4466 W BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3170
Mailing Address - Country:US
Mailing Address - Phone:810-285-8523
Mailing Address - Fax:810-820-9582
Practice Address - Street 1:815 S STATE RD STE A
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-1751
Practice Address - Country:US
Practice Address - Phone:810-652-6178
Practice Address - Fax:810-652-6181
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501015726OtherLICENSE NUMBER