Provider Demographics
NPI:1750687729
Name:SORIANO, JAY-R MORILLO (LMT)
Entity Type:Individual
Prefix:
First Name:JAY-R
Middle Name:MORILLO
Last Name:SORIANO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5537 SHELDON RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3153
Mailing Address - Country:US
Mailing Address - Phone:813-265-2264
Mailing Address - Fax:
Practice Address - Street 1:5537 SHELDON RD
Practice Address - Street 2:SUITE F
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3153
Practice Address - Country:US
Practice Address - Phone:813-265-2264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 61428225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist