Provider Demographics
NPI:1932145372
Name:SHAFFER, SCOTT G (PT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:G
Last Name:SHAFFER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4 ELENA DR
Mailing Address - Street 2:APT A
Mailing Address - City:LA SELVA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:95076
Mailing Address - Country:US
Mailing Address - Phone:831-685-4754
Mailing Address - Fax:
Practice Address - Street 1:9000 SOQUEL AVE
Practice Address - Street 2:STE 101A
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062
Practice Address - Country:US
Practice Address - Phone:831-462-5777
Practice Address - Fax:831-462-5779
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26013225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT260131Medicare ID - Type Unspecified