Healthcare Provider Details

I. General information

NPI: 1275457699
Provider Name (Legal Business Name): MARCEL SOUSA PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 E BAY DR
LARGO FL
33771-2323
US

IV. Provider business mailing address

1917 WOLFORD RD APT A
CLEARWATER FL
33760-1445
US

V. Phone/Fax

Practice location:
  • Phone: 727-587-0582
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT45071
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: