Healthcare Provider Details

I. General information

NPI: 1588763056
Provider Name (Legal Business Name): SCOTT CROSBY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10390 COLOMA RD SUITE 7
RANCHO CORDOVA CA
95670-2152
US

IV. Provider business mailing address

10390 COLOMA RD SUITE 7
RANCHO CORDOVA CA
95670-2152
US

V. Phone/Fax

Practice location:
  • Phone: 916-858-0950
  • Fax: 916-858-0972
Mailing address:
  • Phone: 916-858-0950
  • Fax: 916-858-0972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT22875
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: