Provider Demographics
NPI:1609951326
Name:CAMERON, SCOTT (PT)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:CAMERON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1926
Mailing Address - Country:US
Mailing Address - Phone:860-274-4092
Mailing Address - Fax:860-274-4099
Practice Address - Street 1:114 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413-2112
Practice Address - Country:US
Practice Address - Phone:860-664-9442
Practice Address - Fax:860-664-9227
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6389225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080006389CT08OtherANTHEM BC BS
CT080006389CT11OtherANTHEM BC BS
CT080006389CT09OtherANTHEM BC BS
CT080006389CT10OtherANTHEM BC BS
CT650000931Medicare PIN