Basic Information
| Provider Information | |||||||||
| NPI: | 1295408896 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETERIKA | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | DANIELLE | ||||||||
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| Credential: | ATC, LAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 308 E 7TH AVE | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336022326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8135009722 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3416 S DALE MABRY HWY | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336298639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138373060 | ||||||||
| FaxNumber: | 8138373080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2021 | ||||||||
| LastUpdateDate: | 07/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | AL5392 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.