Healthcare Provider Details

I. General information

NPI: 1073440186
Provider Name (Legal Business Name): PETER D SCOVIL CMT 100710
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 WINGERT ROAD
HAYFORK CA
96041
US

IV. Provider business mailing address

PO BOX 1496
HAYFORK CA
96041-1496
US

V. Phone/Fax

Practice location:
  • Phone: 530-739-8628
  • Fax:
Mailing address:
  • Phone: 530-739-8628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number100710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: