| Organization Name: | SUNCOAST THERAPY, LLC |
| NPI Number: | 1013234608 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAWN WILDERMUTH (OWNER) |
| Mailing Address: | 411 Commercial Ct Ste F Venice |
| State: | FL US |
| Postal Code: | 342921650 |
| Phone Number: | 9414686701 |
| Fax Number: | 9414850519 |
| NPI Enumeration Date: | 04/23/2010 |
| NPI Last Update Date: | 04/23/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SA934 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |