Provider Demographics
NPI:1134788748
Name:TORY, LINDA ANN PENDERGAST
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:ANN PENDERGAST
Last Name:TORY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:PENDERGAST, SOLECKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10019 EAGLE BEND DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-5556
Mailing Address - Country:US
Mailing Address - Phone:586-873-9687
Mailing Address - Fax:
Practice Address - Street 1:10019 EAGLE BEND DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-5556
Practice Address - Country:US
Practice Address - Phone:586-873-9687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT16723225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT16723OtherOT LICENCE