Provider Demographics
NPI:1336500552
Name:SCOTT, PATRICK WYATT (PT)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:WYATT
Last Name:SCOTT
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 1:10790 RANCHO BERNARDO RD
Mailing Address - Street 2:MAIL DROP 4S-205
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:858-927-5775
Mailing Address - Fax:858-605-7380
Practice Address - Street 1:10790 RANCHO BERNARDO RD
Practice Address - Street 2:MAIL DROP 4S-205
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-5705
Practice Address - Country:US
Practice Address - Phone:858-927-5775
Practice Address - Fax:858-605-7380
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19293225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist