Provider Demographics
NPI:1649225905
Name:OSWALT, MICHAEL SCOTT (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:OSWALT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:45 JAN CT
Mailing Address - Street 2:SUITE #165
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-4419
Mailing Address - Country:US
Mailing Address - Phone:530-342-0700
Mailing Address - Fax:530-342-0700
Practice Address - Street 1:45 JAN CT
Practice Address - Street 2:SUITE #165
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-4419
Practice Address - Country:US
Practice Address - Phone:530-342-0700
Practice Address - Fax:530-342-0700
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT25021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT250210Medicare ID - Type UnspecifiedPHYSICAL THERAPIST