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General NPI Number Information
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NPI Number | 1578214912
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Entity Type | Organization
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Legal Business Name | SADDLE UP RIDING CLUB
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Dates
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Enumeration Date | 01/18/2022
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Last Update Date | 01/18/2022
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Provider Practice Location Address
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Address Line | 9301 62ND ST N
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City | PINELLAS PARK
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State | FL
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Zip | 33782-4836
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Country | US
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Telephone | 727-520-3132
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Fax |
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Provider Business Mailing Address
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Address Line | 18217 GULF BLVD
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City | REDINGTON
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State | FL
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Zip | 33708
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Country | US
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Telephone | 727-520-3132
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KELLIE CUNNINGHAM SIPOS
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Credential |
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Telephone | 727-520-3132
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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 |
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License Number State |
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