Provider Demographics
NPI:1710691365
Name:CORE CONNECTION PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:CORE CONNECTION PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SUDHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:757-353-7500
Mailing Address - Street 1:1720 A1A S UNIT E
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-5547
Mailing Address - Country:US
Mailing Address - Phone:757-353-7500
Mailing Address - Fax:
Practice Address - Street 1:1720 A1A S UNIT E
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-5547
Practice Address - Country:US
Practice Address - Phone:757-353-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy