Provider Demographics
NPI:1700076049
Name:NAU, SOKUNTHEA (DPT)
Entity type:Individual
Prefix:DR
First Name:SOKUNTHEA
Middle Name:
Last Name:NAU
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 SW IDOL AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-6726
Mailing Address - Country:US
Mailing Address - Phone:772-342-1020
Mailing Address - Fax:772-210-8920
Practice Address - Street 1:8509 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-3346
Practice Address - Country:US
Practice Address - Phone:772-380-4549
Practice Address - Fax:772-210-8920
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23414208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY9162OtherBCBS
FLY9162OtherBCBS
FLK0935Medicare PIN