Provider Demographics
NPI:1588763056
Name:CROSBY, SCOTT (PT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:CROSBY
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 1:10390 COLOMA RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-2152
Mailing Address - Country:US
Mailing Address - Phone:916-858-0950
Mailing Address - Fax:916-858-0972
Practice Address - Street 1:10390 COLOMA RD
Practice Address - Street 2:SUITE 7
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-2152
Practice Address - Country:US
Practice Address - Phone:916-858-0950
Practice Address - Fax:916-858-0972
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22875225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT228750Medicare PIN