Provider Demographics
NPI:1932338308
Name:SCANLAN, PATRICK KEVIN (PT)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:KEVIN
Last Name:SCANLAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N ATLANTIC BLVD
Mailing Address - Street 2:#B
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3318
Mailing Address - Country:US
Mailing Address - Phone:626-260-8801
Mailing Address - Fax:
Practice Address - Street 1:2630 SAN GABRIEL BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-5204
Practice Address - Country:US
Practice Address - Phone:626-260-8801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27067225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist