Provider Demographics
NPI:1477705424
Name:SCOTT, SHAWN MIGUEL (DPT)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:MIGUEL
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 N GROVE ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2708
Mailing Address - Country:US
Mailing Address - Phone:909-649-1405
Mailing Address - Fax:
Practice Address - Street 1:1521 NORTH GROVE ST.
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2708
Practice Address - Country:US
Practice Address - Phone:909-649-1405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist