Provider Demographics
NPI:1083044218
Name:SERAYDARIAN, AMY R (PT, DPT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:SERAYDARIAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:R
Other - Last Name:MARSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:943 S BENEVA RD STE 204
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-2472
Mailing Address - Country:US
Mailing Address - Phone:941-955-1850
Mailing Address - Fax:941-955-1852
Practice Address - Street 1:8590 POTTER PARK DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-5440
Practice Address - Country:US
Practice Address - Phone:941-922-1156
Practice Address - Fax:941-922-3824
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207451225100000X
FLPT32438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT32438OtherSTATE
VAC05954OtherMEDICARE GROUP PTAN
VA1083044218OtherMEDICAID QMB PROVIDER ID