Provider Demographics
NPI:1982078390
Name:SIKORSKI, KASANDRA
Entity Type:Individual
Prefix:
First Name:KASANDRA
Middle Name:
Last Name:SIKORSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6444 83RD AVE N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-1213
Mailing Address - Country:US
Mailing Address - Phone:866-302-0073
Mailing Address - Fax:
Practice Address - Street 1:6444 83RD AVE N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-1213
Practice Address - Country:US
Practice Address - Phone:866-302-0073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-23
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30975225100000X
IDPT-5888225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist