Provider Demographics
NPI:1760445357
Name:SCOTT, ERICA COLLEEN (PT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:COLLEEN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:COLLEEN
Other - Last Name:BULGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 7493
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-7493
Mailing Address - Country:US
Mailing Address - Phone:714-851-8011
Mailing Address - Fax:
Practice Address - Street 1:170 E 17TH ST
Practice Address - Street 2:SUITE 211
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3701
Practice Address - Country:US
Practice Address - Phone:714-851-8011
Practice Address - Fax:888-979-8144
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25255225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPT25255AMedicare ID - Type Unspecified