Healthcare Provider Details

I. General information

NPI: 1760403505
Provider Name (Legal Business Name): SCOTT KEN SALEE P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 CREEKSIDE DR STE 101
FOLSOM CA
95630-3830
US

IV. Provider business mailing address

5426 BRYCEWOOD WAY
ANTELOPE CA
95843-5908
US

V. Phone/Fax

Practice location:
  • Phone: 916-983-5611
  • Fax: 916-983-5615
Mailing address:
  • Phone: 916-947-1762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License NumberPT12318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: