Provider Demographics
NPI:1033158860
Name:SCOGGIN, STEVEN WARD (MPT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:WARD
Last Name:SCOGGIN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7617 HEATHERLY LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-5602
Mailing Address - Country:US
Mailing Address - Phone:858-335-4096
Mailing Address - Fax:858-484-3350
Practice Address - Street 1:7617 HEATHERLY LN
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-5602
Practice Address - Country:US
Practice Address - Phone:858-335-4096
Practice Address - Fax:858-484-3350
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 24026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT24026OtherPIN