Provider Demographics
NPI:1134130065
Name:CAIN, SCOT L (PTA)
Entity Type:Individual
Prefix:
First Name:SCOT
Middle Name:L
Last Name:CAIN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23062 STEARNS CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-4028
Mailing Address - Country:US
Mailing Address - Phone:949-380-1989
Mailing Address - Fax:509-271-3319
Practice Address - Street 1:3100 W WARNER AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5331
Practice Address - Country:US
Practice Address - Phone:714-545-8946
Practice Address - Fax:714-668-5788
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 2425225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant