Provider Demographics
NPI:1912115510
Name:SCOTT, LONNIE R (MA, ATC)
Entity Type:Individual
Prefix:
First Name:LONNIE
Middle Name:R
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2490 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-4337
Mailing Address - Country:US
Mailing Address - Phone:530-529-3636
Mailing Address - Fax:530-529-3797
Practice Address - Street 1:2490 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-4337
Practice Address - Country:US
Practice Address - Phone:530-529-3636
Practice Address - Fax:530-529-3797
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9313582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer