Provider Demographics
NPI:1245341957
Name:SCOGNAMILLO, PETER ANTHONY JR (DPT ATC CSCS)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:ANTHONY
Last Name:SCOGNAMILLO
Suffix:JR
Gender:M
Credentials:DPT ATC CSCS
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Mailing Address - Street 1:13038 MARITIME PLACE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130
Mailing Address - Country:US
Mailing Address - Phone:858-205-7383
Mailing Address - Fax:858-485-7052
Practice Address - Street 1:9610 GRANITE RIDGE DRIVE SUITE C
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:858-573-0550
Practice Address - Fax:858-573-0550
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-11-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPT28062225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist