Provider Demographics
NPI:1053716183
Name:THURSTON, SCOTT PHILIP (REEGT, REPI, CNIM)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:PHILIP
Last Name:THURSTON
Suffix:
Gender:M
Credentials:REEGT, REPI, CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 W BROWN DEER RD #240
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:43217
Mailing Address - Country:US
Mailing Address - Phone:414-351-6666
Mailing Address - Fax:414-351-6999
Practice Address - Street 1:333 W BROWN DEER RD #240
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:43217
Practice Address - Country:US
Practice Address - Phone:414-351-6666
Practice Address - Fax:414-351-6999
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic