Provider Demographics
NPI:1790107621
Name:RATLIFF, SCOTT (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:RATLIFF
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 VIA COLINA
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-2823
Mailing Address - Country:US
Mailing Address - Phone:760-885-9813
Mailing Address - Fax:
Practice Address - Street 1:24551 RAYMOND WAY
Practice Address - Street 2:SUITE 125
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4400
Practice Address - Country:US
Practice Address - Phone:949-540-0301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-12
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist