Provider Demographics
NPI:1780622837
Name:BADENHORST, TONYA SUE (PT, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:SUE
Last Name:BADENHORST
Suffix:
Gender:F
Credentials:PT, ATC, CSCS
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:SUE
Other - Last Name:STREINZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, ATC, CSCS
Mailing Address - Street 1:7216 US HIGHWAY 301 N
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-3462
Mailing Address - Country:US
Mailing Address - Phone:941-729-0003
Mailing Address - Fax:941-729-0004
Practice Address - Street 1:4134 GULF OF MEXICO DR
Practice Address - Street 2:SUITE 209
Practice Address - City:LONGBOAT KEY
Practice Address - State:FL
Practice Address - Zip Code:34228-2612
Practice Address - Country:US
Practice Address - Phone:941-383-0414
Practice Address - Fax:941-383-0120
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20313225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAG818ZMedicare PIN