Healthcare Provider Details

I. General information

NPI: 1083838676
Provider Name (Legal Business Name): MRS. SOFIA KALIMNIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 SUN CITY CENTER PLZ
SUN CITY CENTER FL
33573-5390
US

IV. Provider business mailing address

5406 FAIR OAKS ST
BRADENTON FL
34203-8815
US

V. Phone/Fax

Practice location:
  • Phone: 813-634-6022
  • Fax: 813-634-6053
Mailing address:
  • Phone: 727-698-4078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA15743
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: