Provider Demographics
NPI:1376084368
Name:SOTERIOU, SELENA (PT)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:SOTERIOU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SELENA
Other - Middle Name:
Other - Last Name:FULKERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15702 BOVINE PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1501
Mailing Address - Country:US
Mailing Address - Phone:502-550-3007
Mailing Address - Fax:
Practice Address - Street 1:15702 BOVINE PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-1501
Practice Address - Country:US
Practice Address - Phone:502-550-3007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 31518225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist