Provider Demographics
NPI:1043234131
Name:CAMPBELL, SCOTT (PT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:CAMPBELL
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 1:935 TRANCAS ST
Mailing Address - Street 2:SUITE 4C
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2932
Mailing Address - Country:US
Mailing Address - Phone:707-255-1212
Mailing Address - Fax:707-226-7409
Practice Address - Street 1:935 TRANCAS ST
Practice Address - Street 2:SUITE 4C
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2932
Practice Address - Country:US
Practice Address - Phone:707-255-1212
Practice Address - Fax:707-226-7409
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23765225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT237650Medicare ID - Type Unspecified