Provider Demographics
NPI:1689007072
Name:SCOTT, TREVOR RAYMOND (DPT)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:RAYMOND
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 1:2016 JACINTO ROAD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40680 CALIFORNIA OAKS RD
Practice Address - Street 2:#2A
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5753
Practice Address - Country:US
Practice Address - Phone:951-894-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40313225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist