=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932145372
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT G SHAFFER PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9000 SOQUEL AVE STE 101A
-----------------------------------------------------
City | SANTA CRUZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-462-5777
-----------------------------------------------------
Fax | 831-462-5779
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 ELENA DR APT A
-----------------------------------------------------
City | LA SELVA BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-685-4754
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT26013
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------