Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 4263 | CA |
NPI | 1013309319 |
---|---|
Provider Name | Mr. Scott Mccrimmon |
First Address | Huntington Beach, CA 92647-5316 |
Second Address | Huntington Beach, CA 92647-5316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2015 |
Last Update Date | 23/02/2015 |