=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508033044
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAYWEST HEALTH AND REHAB LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2008
-----------------------------------------------------
Last Update Date | 06/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5633 STATE ROAD 54
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34652-6020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-372-0091
-----------------------------------------------------
Fax | 727-372-0192
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5633 STATE ROAD 54
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34652-6020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-372-0091
-----------------------------------------------------
Fax | 727-372-0192
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, MANAGING MEMBER
-----------------------------------------------------
Name | DR. SCOTT L COLETTI
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 727-372-0091
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH8153
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------