MEDICARE: DR. SHAWN MIGUEL SCOTT DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	34990	CA

General Provider Information

NPI Number	:	1477705424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAWN MIGUEL SCOTT DPT

Provider Business Mailing Address
First Line	:	1521 N GROVE ST
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92374-2708
Country	:	US
Telephone Number	:	909-649-1405
Fax Number	:

Provider Business Practice Location Address
First Line	:	1521 NORTH GROVE ST.
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92374-2708
Country	:	US
Telephone Number	:	909-649-1405
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	10/21/2008

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