Provider Demographics
NPI:1366612814
Name:SUNCOAST PHYSICAL THERAPY & REHAB. LLC
Entity type:Organization
Organization Name:SUNCOAST PHYSICAL THERAPY & REHAB. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-752-1625
Mailing Address - Street 1:308 53RD AVE E
Mailing Address - Street 2:SUITE 'A'
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-4706
Mailing Address - Country:US
Mailing Address - Phone:941-752-1625
Mailing Address - Fax:941-752-2936
Practice Address - Street 1:308 53RD AVE E
Practice Address - Street 2:SUITE 'A'
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-4706
Practice Address - Country:US
Practice Address - Phone:941-752-1625
Practice Address - Fax:941-752-2936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
18280BOtherBCBS
18280BOtherBCBS