Active NPI
Carl Brent Scott, PT
- Physical Therapist
- Tahlequah, OK
National Provider Identifier
1194768655
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1994
- Practice address
- 2021 Mahaney Ave., Ste. 6
Northeastern Physical Rehab
Tahlequah, OK 74464 - Phone
- (918) 458-5115
- Fax
- (918) 458-5119
- NPI assigned
- Jun 13, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1994 | OK | Primary |
Addresses
Primary practice location
2021 Mahaney Ave., Ste. 6
Northeastern Physical Rehab
Tahlequah, OK 74464
Mailing address
1212 Pinehurst CT.
Fort Gibson, OK 74434
Phone (918) 478-8249
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 650020254 | Other | OK | RR MEDICARE |
| 100834890A | Medicaid | OK | |
| A002 | Other | OK | TRICARE |
| 175254900 | Other | OK | DEPT OF LABOR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1994 | OK | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northeastern Physical Rehab | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapy Clinic/Center
- Tahlequah, OK
- NPI 1275802639
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150156800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1386288000000",
"number": "1194768655",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1212 PINEHURST CT.",
"city": "FORT GIBSON",
"state": "OK",
"postal_code": "74434",
"telephone_number": "918-478-8249"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2021 MAHANEY AVE., STE. 6",
"address_2": "NORTHEASTERN PHYSICAL REHAB",
"city": "TAHLEQUAH",
"state": "OK",
"postal_code": "74464",
"telephone_number": "918-458-5115",
"fax_number": "918-458-5119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCOTT",
"first_name": "CARL",
"middle_name": "BRENT",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-13",
"last_updated": "2013-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OK",
"license": "1994",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "650020254",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100834890A",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "A002",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT OF LABOR",
"identifier": "175254900",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tahlequah, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.