Provider Demographics
NPI:1801479613
Name:VIK, PETRA (LPTA)
Entity type:Individual
Prefix:
First Name:PETRA
Middle Name:
Last Name:VIK
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:PETRA
Other - Middle Name:
Other - Last Name:VIKOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11675 MONUMENT DR UNIT 3201
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-1307
Mailing Address - Country:US
Mailing Address - Phone:251-391-0738
Mailing Address - Fax:
Practice Address - Street 1:8400 VAMO RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-7811
Practice Address - Country:US
Practice Address - Phone:941-966-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30552225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant