Provider Demographics
NPI:1619917127
Name:VANKAMPEN, SCOTT BRYAN (RPT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:BRYAN
Last Name:VANKAMPEN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:996 NW CIRCLE BLVD
Practice Address - Street 2:STE. 101
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-1485
Practice Address - Country:US
Practice Address - Phone:541-757-0878
Practice Address - Fax:541-757-0879
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60142849225100000X
NY017397225100000X, 261QP2000X
OR6166225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1619917127Medicaid
ORP01153283OtherRR MEDICARE
OR500662723Medicaid
WAG8908390Medicare PIN
ORP01153283OtherRR MEDICARE
WA1619917127Medicaid
ORR173996Medicare PIN
ORR172169Medicare PIN