Provider Demographics
NPI:1366657934
Name:TJAN, SCOTT L (PT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:L
Last Name:TJAN
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 1:1374 E CENTURY AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1302
Mailing Address - Country:US
Mailing Address - Phone:480-503-2718
Mailing Address - Fax:
Practice Address - Street 1:7255 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85208-9201
Practice Address - Country:US
Practice Address - Phone:480-981-8844
Practice Address - Fax:480-981-6998
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3090225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ102478Medicare ID - Type UnspecifiedPHYSICAL THERAPIST