Provider Demographics
NPI:1922286129
Name:SUNCOAST SPORTS AND ORTHOPEDIC THERAPY
Entity Type:Organization
Organization Name:SUNCOAST SPORTS AND ORTHOPEDIC THERAPY
Other - Org Name:NEXT STEP REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ P.T.
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MARIANO
Authorized Official - Last Name:KIAG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:727-209-0579
Mailing Address - Street 1:40 66TH STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-8408
Mailing Address - Country:US
Mailing Address - Phone:727-345-3346
Mailing Address - Fax:727-345-3595
Practice Address - Street 1:40 66TH STREET NORTH
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-8408
Practice Address - Country:US
Practice Address - Phone:727-345-3346
Practice Address - Fax:727-345-3595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7410332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5232Medicare UPIN
FL6087100001Medicare NSC