Provider Demographics
NPI:1164464467
Name:SARELAS, STEFANY ANN (PT)
Entity type:Individual
Prefix:MS
First Name:STEFANY
Middle Name:ANN
Last Name:SARELAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7246 4TH AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-1232
Mailing Address - Country:US
Mailing Address - Phone:312-404-1548
Mailing Address - Fax:
Practice Address - Street 1:7246 4TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1232
Practice Address - Country:US
Practice Address - Phone:312-404-1548
Practice Address - Fax:312-470-6550
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-013614225100000X
FLPT33444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty