Provider Demographics
NPI:1578214912
Name:SADDLE UP RIDING CLUB
Entity Type:Organization
Organization Name:SADDLE UP RIDING CLUB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:CUNNINGHAM
Authorized Official - Last Name:SIPOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-520-3132
Mailing Address - Street 1:18217 GULF BLVD
Mailing Address - Street 2:
Mailing Address - City:REDINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33708
Mailing Address - Country:US
Mailing Address - Phone:727-520-3132
Mailing Address - Fax:
Practice Address - Street 1:9301 62ND ST N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-4836
Practice Address - Country:US
Practice Address - Phone:727-520-3132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty