Provider Demographics
NPI:1720264443
Name:WILLIAMS, SCOTT ALLEN (PT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ALLEN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:NO
Other - Middle Name:OTHER
Other - Last Name:NAME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:11890 DONNER PASS RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-0448
Mailing Address - Country:US
Mailing Address - Phone:530-550-0400
Mailing Address - Fax:530-820-9667
Practice Address - Street 1:11890 DONNER PASS RD
Practice Address - Street 2:SUITE 1
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0448
Practice Address - Country:US
Practice Address - Phone:530-550-0400
Practice Address - Fax:530-820-9667
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA188422251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic