MEDICARE: MS. KATHLEEN MARIE SORRENTO P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT8612	FL

General Provider Information

NPI Number	:	1205833803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN MARIE SORRENTO P.T.

Provider Business Mailing Address
First Line	:	8455 S SUNCOAST BLVD
Second Line	:
City	:	HOMOSASSA
State	:	FL
Zip	:	34446-5066
Country	:	US
Telephone Number	:	727-346-0822
Fax Number	:	727-346-0823

Provider Business Practice Location Address
First Line	:	3901 66TH ST N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33709-4911
Country	:	US
Telephone Number	:	727-346-0822
Fax Number	:	727-346-0823

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2005
Last Update Date	:	07/08/2007

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