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General NPI Number Information
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NPI Number | 1205833803
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Entity Type | Individual
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Provider Name | KATHLEEN MARIE SORRENTO P.T.
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Gender | Female
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Dates
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Enumeration Date | 06/29/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3901 66TH ST N
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City | SAINT PETERSBURG
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State | FL
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Zip | 33709-4911
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Country | US
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Telephone | 727-346-0822
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Fax | 727-346-0823
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Provider Business Mailing Address
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Address Line | 8455 S SUNCOAST BLVD
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City | HOMOSASSA
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State | FL
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Zip | 34446-5066
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Country | US
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Telephone | 727-346-0822
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Fax | 727-346-0823
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT8612
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License Number State | FL
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