Individual provider Active NPI

Solmaris Sepulveda Rodriguez, PTA

  • Physical Therapy Assistant
  • Lakeland, FL
National Provider Identifier
1316634066
Registry record updated Apr 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
29293 Issued in FL
Practice address
520 S Florida Ave
Lakeland, FL 33801-5229
Phone
(863) 268-2608
NPI assigned
Apr 21, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 21, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 29293 FL Primary

Addresses

Primary practice location

520 S Florida Ave
Lakeland, FL 33801-5229

Mailing address

1201 Margaret Ave Apt 4
Haines City, FL 33844-5934
Phone (352) 834-5952

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
29293FLMDPhysical Therapy Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1682035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682035200000",
    "number": "1316634066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 MARGARET AVE APT 4",
            "city": "HAINES CITY",
            "state": "FL",
            "postal_code": "338445934",
            "telephone_number": "352-834-5952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 S FLORIDA AVE",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338015229",
            "telephone_number": "863-268-2608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEPULVEDA RODRIGUEZ",
        "first_name": "SOLMARIS",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-04-21",
        "last_updated": "2023-04-21",
        "certification_date": "2023-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "29293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.