Provider Demographics
NPI:1508014416
Name:KORONKA, BRENDA SUE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:SUE
Last Name:KORONKA
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3957 BEACON RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5333
Mailing Address - Country:US
Mailing Address - Phone:352-874-2731
Mailing Address - Fax:
Practice Address - Street 1:1200 OAKLEY SEAVER DR
Practice Address - Street 2:SUITE 204
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1958
Practice Address - Country:US
Practice Address - Phone:352-241-0347
Practice Address - Fax:352-243-3610
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19944225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist