Provider Demographics
NPI:1396776704
Name:BETH SCALONE PT, INC
Entity type:Organization
Organization Name:BETH SCALONE PT, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SCALONE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, OCS
Authorized Official - Phone:858-675-1133
Mailing Address - Street 1:15373 INNOVATION DR
Mailing Address - Street 2:SUITE 175
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3427
Mailing Address - Country:US
Mailing Address - Phone:858-675-1133
Mailing Address - Fax:858-675-1151
Practice Address - Street 1:15373 INNOVATION DR
Practice Address - Street 2:SUITE 175
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3427
Practice Address - Country:US
Practice Address - Phone:858-675-1133
Practice Address - Fax:858-675-1151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ04660ZOtherBLUE CROSS OF CA PROVIDER
CAZZZ04660ZOtherBLUE CROSS OF CA PROVIDER