Provider Demographics
NPI:1720445901
Name:SOTOLONGO PEREZ, EDUARDO (PTA)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:SOTOLONGO PEREZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 PACIFIC BLVD APT 204
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-6788
Mailing Address - Country:US
Mailing Address - Phone:786-506-1152
Mailing Address - Fax:
Practice Address - Street 1:5520 PACIFIC BLVD APT 204
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-6788
Practice Address - Country:US
Practice Address - Phone:786-506-1152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA26293225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant