Healthcare Provider Details

I. General information

NPI: 1902388606
Provider Name (Legal Business Name): EUGINA STOKES PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37135 COLEMAN AVE
DADE CITY FL
33525-4526
US

IV. Provider business mailing address

8935 WOODLEAF BLVD
WESLEY CHAPEL FL
33544-2672
US

V. Phone/Fax

Practice location:
  • Phone: 352-567-8615
  • Fax:
Mailing address:
  • Phone: 813-509-1612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number23070
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: