MEDICARE: DR. SOKUNTHEA NAU DPT

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	208100000X	Physical Medicine & Rehabilitation Physician	PT23414	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y9162	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1700076049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOKUNTHEA NAU DPT

Provider Business Mailing Address
First Line	:	816 SW IDOL AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-6726
Country	:	US
Telephone Number	:	772-342-1020
Fax Number	:	772-210-8920

Provider Business Practice Location Address
First Line	:	8509 S US HIGHWAY 1
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-3346
Country	:	US
Telephone Number	:	772-380-4549
Fax Number	:	772-210-8920

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

Provider Enumeration Date	:	08/01/2007
Last Update Date	:	01/30/2017

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