Basic Information
| Provider Information | |||||||||
| NPI: | 1437266723 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCOTT | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | M.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1618 MILLENIUM WAY | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836426439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088844647 | ||||||||
| FaxNumber: | 2088848984 | ||||||||
| Practice Location | |||||||||
| Address1: | 1618 MILLENIUM WAY | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836426439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088844647 | ||||||||
| FaxNumber: | 2088848984 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 10/30/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | RPT1680 | ID | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 807248200 | 05 | ID | MEDICAID |