Healthcare Provider Details

I. General information

NPI: 1477486785
Provider Name (Legal Business Name): GAVIN STEPHEN SCARBROUGH-KIDD LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 SILVERBELL RD
CHICO CA
95973-0386
US

IV. Provider business mailing address

3435 SILVERBELL RD
CHICO CA
95973-0386
US

V. Phone/Fax

Practice location:
  • Phone: 530-774-2261
  • Fax: 530-774-2378
Mailing address:
  • Phone: 530-774-2261
  • Fax: 530-774-2378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAT-17964
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: