Provider Demographics
NPI:1396815189
Name:JENNINGS, SCOTT W (MSPT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:W
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:854 MALIBU DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-2671
Mailing Address - Country:US
Mailing Address - Phone:925-969-1628
Mailing Address - Fax:925-969-1628
Practice Address - Street 1:1111 E STANLEY BLVD
Practice Address - Street 2:BLDG B, SUITE112
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4115
Practice Address - Country:US
Practice Address - Phone:800-919-8090
Practice Address - Fax:925-243-0127
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 20679225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist