Provider Demographics
NPI:1568487296
Name:SCALONE, BETH ANN (DPT, OCS)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:ANN
Last Name:SCALONE
Suffix:
Gender:F
Credentials:DPT, OCS
Other - Prefix:MISS
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:STETSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:12171 WORLD TRADE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3709
Mailing Address - Country:US
Mailing Address - Phone:858-674-4480
Mailing Address - Fax:858-674-0769
Practice Address - Street 1:12171 WORLD TRADE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3709
Practice Address - Country:US
Practice Address - Phone:858-674-4480
Practice Address - Fax:858-674-0769
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18321OtherCA PHYSICAL THERAPY LIC#
WPT18321AMedicare ID - Type Unspecified