Provider Demographics
NPI:1235673914
Name:PENINGTON, SCOTT ALAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALAN
Last Name:PENINGTON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12121 HARBOUR REACH DR
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-5314
Mailing Address - Country:US
Mailing Address - Phone:425-493-8313
Mailing Address - Fax:
Practice Address - Street 1:4410 106TH ST SW
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-4700
Practice Address - Country:US
Practice Address - Phone:425-493-6080
Practice Address - Fax:425-339-4219
Is Sole Proprietor?:No
Enumeration Date:2016-12-14
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38262225100000X
WAPT60689962225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist