Provider Demographics
NPI:1902863392
Name:SUNCOAST PHYSICAL TRAINING & REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:SUNCOAST PHYSICAL TRAINING & REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRISH
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-571-3222
Mailing Address - Street 1:PO BOX 6813
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33758-6813
Mailing Address - Country:US
Mailing Address - Phone:727-571-3222
Mailing Address - Fax:727-573-0332
Practice Address - Street 1:10863 PARK BLVD STE 4
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-5423
Practice Address - Country:US
Practice Address - Phone:727-571-3222
Practice Address - Fax:727-573-0332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT5624261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106751Medicare Oscar/Certification