Provider Demographics
NPI:1447884614
Name:SCOTT CAMPBELL PHYSICAL THERAPY
Entity type:Organization
Organization Name:SCOTT CAMPBELL PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-456-9705
Mailing Address - Street 1:29575 PACIFIC COAST HWY STE P
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-3960
Mailing Address - Country:US
Mailing Address - Phone:310-456-9705
Mailing Address - Fax:310-919-1133
Practice Address - Street 1:29575 PACIFIC COAST HWY STE P
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-3960
Practice Address - Country:US
Practice Address - Phone:310-456-9705
Practice Address - Fax:310-919-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty