| Suncoast Behavioral Medicine, Inc | |
|
4370 S Tamiami Trl Suite 241 Sarasota FL 34231-3412 | |
| (941) 926-2474 | |
| (941) 926-2440 |
| Full Name | Suncoast Behavioral Medicine, Inc |
|---|---|
| Speciality | Physical Therapist |
| Location | 4370 S Tamiami Trl, Sarasota, Florida |
| Authorized Official Name and Position | William Baker (PRESIDENT) |
| Authorized Official Contact | 9419262474 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Suncoast Behavioral Medicine, Inc 4370 S Tamiami Trl Suite 241 Sarasota FL 34231-3412 Ph: (941) 926-2474 | Suncoast Behavioral Medicine, Inc 4370 S Tamiami Trl Suite 241 Sarasota FL 34231-3412 Ph: (941) 926-2474 |
| NPI Number | 1306993654 |
|---|---|
| Provider Enumeration Date | 01/05/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 6507889797 |
|---|---|
| Medicare Enrollment ID | O20060113000597 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306993654 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | MH4720 (Florida) | Primary |
| 103T00000X | Psychologist | PY 5729 (Florida) | Primary |
| 225100000X | Physical Therapist | PT13914 (Florida) | Primary |
| Provider Name | Joanna R Baker |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1124175484 PECOS PAC ID: 6507850757 Enrollment ID: I20040412001012 |
| Provider Name | William K Baker |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1528115888 PECOS PAC ID: 0042233231 Enrollment ID: I20060118000686 |
| Provider Name | Joanna R Baker |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1124175484 PECOS PAC ID: 6507850757 Enrollment ID: I20240126003532 |
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