Provider Demographics
NPI:1366595498
Name:KIAG, STEVEN MARIANO (PT)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:MARIANO
Last Name:KIAG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 66TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-8408
Mailing Address - Country:US
Mailing Address - Phone:727-345-3346
Mailing Address - Fax:727-345-3595
Practice Address - Street 1:5535 PARK ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-6309
Practice Address - Country:US
Practice Address - Phone:727-209-0579
Practice Address - Fax:727-209-0580
Is Sole Proprietor?:No
Enumeration Date:2007-01-20
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 7410225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ07283Medicare UPIN
FLY6114ZMedicare ID - Type UnspecifiedMEDICARE SUFFIX