Provider Demographics
NPI:1417098807
Name:FIRLEJ, RENATA (P/T)
Entity Type:Individual
Prefix:MRS
First Name:RENATA
Middle Name:
Last Name:FIRLEJ
Suffix:
Gender:F
Credentials:P/T
Other - Prefix:MRS
Other - First Name:RENATA
Other - Middle Name:
Other - Last Name:FIRLEJ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:P/T
Mailing Address - Street 1:7947 LIMESTONE LN
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-3250
Mailing Address - Country:US
Mailing Address - Phone:224-577-5691
Mailing Address - Fax:
Practice Address - Street 1:7947 LIMESTONE LN
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-3250
Practice Address - Country:US
Practice Address - Phone:224-577-5691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2014-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26297225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
070006768OtherPT IL LICENSE
04932419OtherBCBS
FL26297OtherPT FLORIDA LICENCE
0493241POtherBCBS
070006768OtherPT IL LICENSE
0493241POtherBCBS