1932366929 NPI number — SUNCOAST SPORTS AND ORTHOPEDIC THERAPY

Table of content: (NPI 1932366929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932366929 NPI number — SUNCOAST SPORTS AND ORTHOPEDIC THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNCOAST SPORTS AND ORTHOPEDIC THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NEXT STEP REHABILITATION
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932366929
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 66TH STREET NORTH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST. PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33710-8408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-345-3346
Provider Business Mailing Address Fax Number:
727-345-3595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3690 E BAY DRIVE
Provider Second Line Business Practice Location Address:
STE S
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33771-1946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-532-0005
Provider Business Practice Location Address Fax Number:
727-524-9060
Provider Enumeration Date:
05/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KIAG
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
MARIANO
Authorized Official Title or Position:
OWNER/PHYSICAL THERAPIST
Authorized Official Telephone Number:
727-345-3346

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  PT7410 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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