MEDICARE: MR. SCOTT LEITH LEGIER MT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172M00000X	Mechanotherapist	286	CA

General Provider Information

NPI Number	:	1386996254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT LEITH LEGIER MT

Provider Business Mailing Address
First Line	:	2171 S EL CAMINO REAL
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6229
Country	:	US
Telephone Number	:	858-204-0955
Fax Number	:

Provider Business Practice Location Address
First Line	:	2171 S EL CAMINO REAL
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6229
Country	:	US
Telephone Number	:	858-204-0955
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2012
Last Update Date	:	10/02/2012

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