Provider Demographics
NPI:1669632063
Name:SCAFARIO, MARIA DELAZZER (PT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DELAZZER
Last Name:SCAFARIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 SR 64 E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212
Mailing Address - Country:US
Mailing Address - Phone:941-792-1404
Mailing Address - Fax:941-761-0712
Practice Address - Street 1:8340 LAKEWOOD RANCH BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5183
Practice Address - Country:US
Practice Address - Phone:941-792-1404
Practice Address - Fax:941-795-1717
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23614225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619980OtherBCBS OF IL
FLK7640Medicare PIN
ILK53403Medicare PIN
IL567700Medicare PIN
IL1619980OtherBCBS OF IL
ILK53401Medicare PIN
IL568150Medicare PIN
ILK53402Medicare PIN