Provider Demographics
NPI:1912933532
Name:WOFFINDEN, SCOTT JOHN (PA-C, PT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:JOHN
Last Name:WOFFINDEN
Suffix:
Gender:M
Credentials:PA-C, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2832 E DOWNING CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-6929
Mailing Address - Country:US
Mailing Address - Phone:480-924-2022
Mailing Address - Fax:
Practice Address - Street 1:3825 N 24TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6512
Practice Address - Country:US
Practice Address - Phone:602-955-7997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5823225100000X
AZ4966363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ838914Medicaid
AZP00063839Medicare PIN
AZP00063839Medicare UPIN
AZ838914Medicaid