Provider Demographics
NPI:1295408896
Name:PETERIKA, SARAH DANIELLE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:DANIELLE
Last Name:PETERIKA
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 E 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-2326
Mailing Address - Country:US
Mailing Address - Phone:813-500-9722
Mailing Address - Fax:
Practice Address - Street 1:3416 S DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-8639
Practice Address - Country:US
Practice Address - Phone:813-837-3060
Practice Address - Fax:813-837-3080
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL53922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer