Healthcare Provider Details

I. General information

NPI: 1053874503
Provider Name (Legal Business Name): SEYEDEH MITRA SOLTANPANAHI DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6235 HOFFMAN ST
NORTH PORT FL
34287-2285
US

IV. Provider business mailing address

6235 HOFFMAN ST
NORTH PORT FL
34287-2285
US

V. Phone/Fax

Practice location:
  • Phone: 716-748-9956
  • Fax: 855-232-8604
Mailing address:
  • Phone: 716-748-9956
  • Fax: 855-232-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number31757
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: