Provider Demographics
NPI:1871592857
Name:DANIELS, SCOTT GREGORY (PT)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:GREGORY
Last Name:DANIELS
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 1:4701 CREEK RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-8398
Mailing Address - Country:US
Mailing Address - Phone:513-544-8080
Mailing Address - Fax:513-544-8082
Practice Address - Street 1:4701 CREEK RD
Practice Address - Street 2:SUITE 110
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-8398
Practice Address - Country:US
Practice Address - Phone:513-544-8080
Practice Address - Fax:513-544-8082
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-08283225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2506998Medicaid
OH2506998Medicaid
OH4139632Medicare PIN