Provider Demographics
NPI:1790888675
Name:PHYSICAL THERAPY OF SARASOTA
Entity Type:Organization
Organization Name:PHYSICAL THERAPY OF SARASOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KISIELEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:941-365-2830
Mailing Address - Street 1:2650 BAHIA VISTA ST
Mailing Address - Street 2:STE. 101
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2635
Mailing Address - Country:US
Mailing Address - Phone:941-365-2830
Mailing Address - Fax:941-955-1559
Practice Address - Street 1:2650 BAHIA VISTA ST
Practice Address - Street 2:STE. 101
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2635
Practice Address - Country:US
Practice Address - Phone:941-365-2830
Practice Address - Fax:941-955-1559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT5346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CL5980OtherRAILROAD MEDICARE
FLK1255Medicare ID - Type Unspecified