Provider Demographics
NPI:1992402846
Name:ST. PETE PHYSICAL THERAPY
Entity type:Organization
Organization Name:ST. PETE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHORPION
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:727-490-9487
Mailing Address - Street 1:3642 BAYSHORE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-5514
Mailing Address - Country:US
Mailing Address - Phone:908-872-0621
Mailing Address - Fax:
Practice Address - Street 1:11210 BLUE HERON BLVD
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716
Practice Address - Country:US
Practice Address - Phone:727-490-9487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy