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General NPI Number Information
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NPI Number | 1710469184
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Entity Type | Individual
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Provider Name | ENIKO KORODI
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Gender | Female
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Dates
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Enumeration Date | 09/03/2018
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Last Update Date | 09/03/2018
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Provider Practice Location Address
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Address Line | 4000 KINGS HWY
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City | PORT CHARLOTTE
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State | FL
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Zip | 33980
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Country | US
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Telephone | 941-356-1741
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Fax |
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Provider Business Mailing Address
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Address Line | 12077 WARDEN AVE
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City | PORT CHARLOTTE
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State | FL
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Zip | 33981
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Country | US
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Telephone | 941-356-1741
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 28234
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License Number State | FL
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