Healthcare Provider Details

I. General information

NPI: 1124289434
Provider Name (Legal Business Name): NICOLE WEITHAAS SCOTT MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 04/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N 1ST ST STE 103
BURBANK CA
91502-1845
US

IV. Provider business mailing address

100 N 1ST ST STE 103
BURBANK CA
91502-1845
US

V. Phone/Fax

Practice location:
  • Phone: 818-846-7100
  • Fax: 818-846-7101
Mailing address:
  • Phone: 818-846-7100
  • Fax: 818-846-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number27834
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: