Healthcare Provider Details

I. General information

NPI: 1861177644
Provider Name (Legal Business Name): KATHERINE SCANLON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 J ST STE 230
SACRAMENTO CA
95816-4307
US

IV. Provider business mailing address

177 TOWNSEND ST UNIT 616
SAN FRANCISCO CA
94107-5907
US

V. Phone/Fax

Practice location:
  • Phone: 916-497-0790
  • Fax:
Mailing address:
  • Phone: 240-401-3994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number304065
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: