Provider Demographics
NPI:1790870764
Name:LAURENTE, SCOTT MICHAEL (PT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:MICHAEL
Last Name:LAURENTE
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 1:2400 BAHAMAS DR
Mailing Address - Street 2:STE. 110
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0745
Mailing Address - Country:US
Mailing Address - Phone:661-328-2388
Mailing Address - Fax:818-901-4529
Practice Address - Street 1:2400 BAHAMAS DR
Practice Address - Street 2:STE. 110
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0745
Practice Address - Country:US
Practice Address - Phone:661-328-2388
Practice Address - Fax:818-901-4529
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT154822251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP66418Medicare UPIN
CAOPT154821Medicare ID - Type Unspecified