Provider Demographics
NPI:1982094108
Name:AQUINO, LAURENCE PEREZ (DPT,PT,MBA,OCS)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:PEREZ
Last Name:AQUINO
Suffix:
Gender:M
Credentials:DPT,PT,MBA,OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 EAGLE BAY LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-8370
Mailing Address - Country:US
Mailing Address - Phone:912-512-2261
Mailing Address - Fax:866-728-7817
Practice Address - Street 1:9375 EMERALD COAST PKWY W # A-1
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-7274
Practice Address - Country:US
Practice Address - Phone:850-278-3770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010369225100000X
FLPT29722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist