Provider Demographics
NPI:1508161266
Name:SISTOSO, ERLINDA PANGANIBAN (PT)
Entity Type:Individual
Prefix:MRS
First Name:ERLINDA
Middle Name:PANGANIBAN
Last Name:SISTOSO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 48TH ST W
Mailing Address - Street 2:UNIT 813
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-2892
Mailing Address - Country:US
Mailing Address - Phone:216-268-9061
Mailing Address - Fax:
Practice Address - Street 1:5612 26TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-3515
Practice Address - Country:US
Practice Address - Phone:941-751-6532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 26144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist