Healthcare Provider Details

I. General information

NPI: 1790441053
Provider Name (Legal Business Name): CYNTHIA SEIDE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 MARINER BLVD
SPRING HILL FL
34609-5691
US

IV. Provider business mailing address

7137 CARMEL AVE
NEW PORT RICHEY FL
34655-2512
US

V. Phone/Fax

Practice location:
  • Phone: 352-683-2120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA31431
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: