Healthcare Provider Details

I. General information

NPI: 1447884614
Provider Name (Legal Business Name): SCOTT CAMPBELL PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29575 PACIFIC COAST HWY STE P
MALIBU CA
90265-3960
US

IV. Provider business mailing address

29575 PACIFIC COAST HWY STE P
MALIBU CA
90265-3960
US

V. Phone/Fax

Practice location:
  • Phone: 310-456-9705
  • Fax: 310-919-1133
Mailing address:
  • Phone: 310-456-9705
  • Fax: 310-919-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SCOTT LLOYD CAMPBELL
Title or Position: OWNER
Credential:
Phone: 310-456-9705