Provider Demographics
NPI:1023147279
Name:SORIANO, EDWIN MUNOZ (PT)
Entity type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:MUNOZ
Last Name:SORIANO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 AVENUE C SW
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3273
Mailing Address - Country:US
Mailing Address - Phone:863-293-3700
Mailing Address - Fax:863-292-0417
Practice Address - Street 1:141 AVENUE C SW
Practice Address - Street 2:SUITE 150
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3273
Practice Address - Country:US
Practice Address - Phone:863-293-3700
Practice Address - Fax:863-292-0417
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT6404225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL213840OtherAMERIGROUP
FLY910JOtherBCBS GROUP NO.
FL826886OtherAETNA HMO
FLY910GOtherBCBS GROUP NO.
FL5239004OtherAETNA PPO
FL102318OtherAVMED
FLY4691OtherBCBS INDIVIDUAL NO.
FL5239004OtherAETNA PPO
FLK0936BMedicare ID - Type UnspecifiedGROUP NO.
FLK0936Medicare ID - Type UnspecifiedGROUP NO.