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NPI Code Detail

MEDICARE: LONNIE R. SCOTT MA, ATC

MEDICARE: LONNIE R. SCOTT MA, ATC
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
12255A2300XAthletic Trainer931358CA

General Provider Information

NPI Number : 1912115510
Entity Type Code : Individual
Provider Name (Legal Business Name) : LONNIE R. SCOTT MA, ATC
Provider Business Mailing Address
First Line : 2490 S MAIN ST
Second Line :
City : RED BLUFF
State : CA
Zip : 96080-4337
Country : US
Telephone Number : 530-529-3636
Fax Number : 530-529-3797
Provider Business Practice Location Address
First Line : 2490 S MAIN ST
Second Line :
City : RED BLUFF
State : CA
Zip : 96080-4337
Country : US
Telephone Number : 530-529-3636
Fax Number : 530-529-3797
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2007
Last Update Date : 07/08/2007

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