Provider Demographics
NPI:1285117218
Name:SCOTT, CIARA JEAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:CIARA
Middle Name:JEAN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15977 HARWICH CT
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-9019
Mailing Address - Country:US
Mailing Address - Phone:574-222-3957
Mailing Address - Fax:
Practice Address - Street 1:4200 LATHAM ST STE C1
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-1780
Practice Address - Country:US
Practice Address - Phone:951-289-9454
Practice Address - Fax:951-289-9456
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist