Provider Demographics
NPI:1588738074
Name:SUNCOAST SPORTS AND ORTHOPEDIC THERAPY
Entity type:Organization
Organization Name:SUNCOAST SPORTS AND ORTHOPEDIC THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:B
Authorized Official - Last Name:WHITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:727-345-3346
Mailing Address - Street 1:40 66TH STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-8408
Mailing Address - Country:US
Mailing Address - Phone:727-345-3346
Mailing Address - Fax:727-345-3595
Practice Address - Street 1:40 66TH STREET NORTH
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-8408
Practice Address - Country:US
Practice Address - Phone:727-345-3346
Practice Address - Fax:727-345-3595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
6087100003Medicare NSC
FLK5232Medicare UPIN