Healthcare Provider Details

I. General information

NPI: 1992402846
Provider Name (Legal Business Name): ST. PETE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 02/10/2023
Certification Date: 02/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11210 BLUE HERON BLVD
ST PETERSBURG FL
33716
US

IV. Provider business mailing address

3642 BAYSHORE BLVD NE
ST PETERSBURG FL
33703-5514
US

V. Phone/Fax

Practice location:
  • Phone: 727-490-9487
  • Fax:
Mailing address:
  • Phone: 908-872-0621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAN SCHORPION
Title or Position: OWNER, DOCTOR OF PHYSICAL THERAPY
Credential: DPT
Phone: 727-490-9487