Healthcare Provider Details

I. General information

NPI: 1275596512
Provider Name (Legal Business Name): SCOTT GREGORY DPT, OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 QUINCY AVE APT B
LONG BEACH CA
90803-7402
US

IV. Provider business mailing address

5 QUINCY AVE APT B
LONG BEACH CA
90803-7402
US

V. Phone/Fax

Practice location:
  • Phone: 310-570-8424
  • Fax: 562-548-7656
Mailing address:
  • Phone: 310-570-8424
  • Fax: 562-548-7656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT28389
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: