Provider Demographics
NPI:1568584134
Name:CAMPBELL, SCOTT LLOYD (PT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:LLOYD
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:29575 PACIFIC COAST HWY.
Mailing Address - Street 2:STE. P
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265
Mailing Address - Country:US
Mailing Address - Phone:310-456-9705
Mailing Address - Fax:310-919-1133
Practice Address - Street 1:29575 PACIFIC COAST HWY.
Practice Address - Street 2:STE. P
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265
Practice Address - Country:US
Practice Address - Phone:310-456-9705
Practice Address - Fax:310-919-1133
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT165522251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT16552AMedicare PIN